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Bilateral adrenal thickening

Adrenal Gland Pathology - StudyBlue

Size and location: The adrenal glands can increase in size due to hyperplasia (usually bilateral) or a tumor (adenoma or carcinoma). However, hyperplasia may give rise t.. Bilateral hyperplasia is one cause of primary aldosteronism (also sometimes referred to as primary hyperaldosteronism). Other causes are adrenal adenomas, adrenal carcinoma, and inherited.. Dr Yahya Baba and Assoc Prof Frank Gaillard et al. The differential for bilaterally enlarged adrenal glands ( adrenomegaly) is relatively limited: adrenal hyperplasia. micronodular adrenal hyperplasia. macronodular adrenal hyperplasia. adrenocorticotropin (ACTH)-independent macronodular adrenocortical hyperplasia (AIMAH) 2

Elusive pulmonary symptoms prove difficult to pin down

Bilateral adrenal enlargement was found without a plausible cause. Endoscopy revealed a reflux oesophagitis grade I, which was treated with famotidine. His complaints disappeared without further treatment Minor adrenal nodularity or thickening is most problematic when seen in a patient with a known primary malignancy, because of the concern that such abnormalities are an early sign of metastases. This concern is particularly acute in patients with primary lung cancer, where the frequency of metastases to the adrenal glands is very high Bilateral adrenal hyperplasia represents one-third of cases of classical primary aldosteronism. Some also use the term idiopathic hyperaldosteronism (IHA); the terms are often used interchangeably

thickening adrenal gland causes Answers from Doctors

Bilateral Hyperplasia of the Adrenal Gland - Cancer

Bilateral adrenal gland enlargement Radiology Reference

  1. Adrenal Nodules. Adrenal nodules are found in approximately 5-8% of all patients. The vast majority are benign (non-cancerous) and do not produce excess amounts of hormone. Most adrenal nodules do not cause any symptoms and are found only when imaging studies (CT scans, MRIs) are obtained to evaluate symptoms related to another problem
  2. Doctors don't know what causes adrenal gland adenomas, but you're more likely to get one if you have certain genetic conditions, such as: Familial adenomatous polyposis (FAP). This is a rare..
  3. A, Unenhanced CT (A), early contrast-enhanced CT (B), and delayed contrast-enhanced CT (C) images show diffusely thick bilateral adrenal glands. ROI is placed on thickest area of right (large arrow) and left (small arrow) adrenal glands
Ultrasound showing right adrenal hematoma (seventh day of

The adrenal glands produce hormones that play a key role in keeping the body in balance. A nodule can disrupt adrenal gland function and trigger a wide variety of symptoms, such as unexplained changes in body weight, high blood pressure, headaches, muscle spasms, decreased sex drive and fatigue. In some cases, however, a nodule may not cause. In bilateral adrenal hyperplasia, the medulla may be seen as a highly echogenic linear structure on US and a high-density linear structure on CT. The other causes of diffuse adrenal enlargement are hemorrhage, infectious disease, infiltrating neoplastic disease, and congenital metabolic deficiency disease what does low density nodular thickening of both adrenal glands without suspicious enhancement,presumably on the basis of small adenomas mean on my c? Answered by Dr. Clarence Grim: Nodular adrenals: You may have a form of Conn's Syndrome. Come to my Y.. Cushing's syndrome, named after Dr. Harvey Cushing who described it, occurs when the adrenal glands secrete excessive amounts of the hormone hydrocortisone that they normally make. The adrenal gland is an endocrine gland, meaning that it makes hormones which it releases into the blood stream for distribution to all the cells of the body

Nodular thickening of the adrenal gland is from hyperplasia. When adrenal gland is diffusely enlarged, it initially becomes thickened. Diffuse hyperplasia of the adrenal gland is characterized by diffuse, uniform thickening with a smooth contour An adrenal gland on top of a kidney. An adrenal nodule is a mass that forms from unchecked cellular reproduction within the adrenal gland. Usually comprised of neuroendocrine cells, it is generally benign in its composition. Often, symptomatic individuals possess a genetic predisposition for the development of these nodules

Adrenal hemorrhage is an uncommon but potentially life-threatening condition, particularly in cases of bilateral adrenal hemorrhage causing primary adrenal insufficiency. It is difficult to diagnose clinically, particularly in critically ill patients, given its non-specific symptoms and signs, which include abdominal pain, vomiting, fever, weakness, hypotension, and altered conscious state Hyperplasia can be seen as a diffuse process, that may involve the entire adrenal gland, or nodular hyperplasia, and it is typically bilateral (13,23). Diffuse hyperplasia is usually characterized by homogeneous thickening of the entire adrenal gland, maintaining its overall normal inverted-V or inverted-Y appearance ( 1 ) Bilateral disease—primary pigmented nodular adrenal dysplasia (PPNAD) (n = 2) and ACTH-independent macronodular adrenal hyperplasia (AIMAH) (n = 1)—had characteristic imaging features. In PPNAD, multiple tiny (2-5-mm) nodules were visible bilaterally, with no overall glandular enlargement and normal intervening adrenal tissue Background: Management of patients with bilateral adrenal masses and ACTH-independent Cushing's syndrome (AICS) is challenging, as bilateral adrenalectomy can lead to steroid dependence and lifelong risk of adrenal crisis. Adrenal venous sampling (AVS) has been previously reported to facilitate lateralization for guiding adrenalectomy. The aim of the current study was to investigate the.

Showing diffuse thickening of bilateral adrenal glands (white arrow) with ongoing stranding. Within 1 day of initiation of regular intravenous hydrocortisone 50 mg every 6 h, the hemodynamic status rapidly improved allowing the discontinuation of all vasopressors Background. Adrenal haemorrhage has a variety of symptoms and causes. 1-4 Bilateral adrenal haemorrhage with acute clinical manifestations is uncommon, but rapid aggravation of adrenal insufficiency is a potentially life-threatening event. We describe a case of acute adrenal insufficiency caused by bilateral adrenal haemorrhage that was followed up with serial imaging Bilateral adrenal hemorrhage is mainly associated with non-traumatic conditions. In early disease, adrenal lymphoma may present as adrenal enlargement and thickening, maintaining the triangular shape of the adrenal gland because of the diffuse infiltration of lymphoid cells . This feature is similar to the appearance of adrenal hyper-plasia

significance of left adrenal gland thickening - Adrenal Insufficiency Community - Dec 12, 2011 Is an incidental finding of a left adrenal gland thickening worth investigating isolated thickening of adrenal gland is not cancerous. it is better TO take second opinion, to rule out any hormonal imbalance because of it. One more thing is to get PET ct abdomen, that can also help to rule out any malignancy or infectio Adrenal tumor: Approximately 10% of patients with Cushing's syndrome have an adrenal tumor, most commonly a benign adrenal nodule or bilateral adrenal hyperplasia that is producing excess cortisol directly. Adrenal cancer produces excess cortisol about 50% of the time, but it is a very rare tumor Bilateral Adrenal Adenomas - Adrenal diseases. kimcadie. June 25, 2014 at 12:10 am; 14 replies; TODO: Email modal placeholder. Approximately 3 months ago I was told I have Bilateral Adrenal adenomas, My primary Dr. sent me to a surgeon because she said that's all she knew to do. Seen the Surgeon who told me they do not like to remove these.

Bulky right hilar and mediastinal lympadenopathy is present, exerting mass effect on the hilar vessels. Complete encasement without obliteration of the right upper lobe segmental artery. Near complete encasement without obliteration of the superior vena cava. Hyperattenuating material in the gallbladder, left adrenal thickening is present An adrenal metastasis is a cancer which has spread from another primary site to one or both adrenal glands. This is relatively common in many cancers. Nearly any cancer can spread to the adrenal glands, but some tumors are more likely than others to metastasize to this region. Having a cancer that has spread to the adrenal gland (s), means that. Adrenal cancer, also called adrenocortical cancer, can occur at any age. But it's most likely to affect children younger than 5 and adults in their 40s and 50s. When adrenal cancer is found early, there is a chance for cure. But if the cancer has spread to areas beyond the adrenal glands, cure becomes less likely. Treatment can be used to delay. The thickening of the adrenal gland can be a symptom of cancer. If it is not the result of cancer then typically it is ignored and looked at five or six months later Bilateral adrenal hyperplasia may be discovered in the work-up of a patient who exhibits features of Cushing's syndrome in the absence of exogenous steroid administration. An important step in.

Bilateral adrenal enlargement as a first sign of systemic

Adrenal tumors are cancerous or noncancerous growths on the adrenal glands. The cause of most adrenal tumors is unknown. Risk factors for adrenal tumors can include Carney complex, Li-Fraumeni syndrome, multiple endocrine neoplasia type 2 and neurofibromatosis type 1 Primary Hyperaldosteronism is a disease caused by an adrenal tumor that produces excess of the hormone aldosterone. The excess aldosterone from the adrenal tumor causes high blood pressure and is named Conn's Syndrome after the doctor who discovered it. Although, the symptoms may be mild, too much aldosterone in the long term is very toxic. eral adrenal limb thickening, unilateral microadenomas ( 1 cm), or bilateral macroadenomas. In these cases, additional testing may be required to determine the source of excess aldosterone secretion. Small APAs may be labeled incor-rectly as IHA on the basis of CT findings of bilateral nodu-larity or normal-appearing adrenals. Also, apparent. Adenoma. About 75% of incidentally discovered adrenal lesions are adenomas and 78% of these are lipid rich [].The majority of adrenal adenomas are non-functioning and about 20% are bilateral [3, 10].Adrenal adenoma with enlargement of the rest of the adrenal gland parenchyma is suggestive of functioning adenoma with adrenal hyperplasia [11, 12].]. In one study, bilateral adrenal adenomas and. adrenal cortical carcinoma, hyperfunctioning adrenal tumor) (Fig. 1). can be applied to patients with bilateral adrenal masses, with each lesion assessed separately. Although the gists identify subcentimeter nodularity or adrenal thickening and are uncertain whether such finding

A positive postural test was defined by an ambulatory PAC 30% greater than that of the supine baseline level. 3, 11, 19 Bilateral adrenal venous sampling (AVS) for aldosterone and cortisol concentrations was offered to patients with a negative (normal) scan or other abnormal scan findings. 20 Blood samples were obtained from the inferior vena cava (IVC) and the right and left adrenal vein Other common cancers that spread to this region include kidney cancer, melanoma, breast cancer, colon cancer, and lymphoma. Up to 40% of people with lung cancer will develop adrenal metastases at some time, and in 10% of people with non-small cell lung cancer, the disease spreads to both adrenal glands. These metastases are present in 2% to 3%.

If imaging shows bilateral adrenal gland thickening or micronodular changes, the diagnosis is bilateral adrenal hyperplasia or idiopathic hyperaldosteronism. If adrenal venous sampling confirms bilateral aldosterone production, medical management with an aldosterone receptor antagonist should be undertaken Adrenal hemorrhage. Adrenal hemorrhage also called adrenal apoplexy, is a relatively rare condition with a variable and nonspecific presentation that may lead to acute adrenal crisis, shock and death unless it is recognized promptly and treated appropriately 1).Several risk factors have been associated with adrenal hemorrhage, based on case reports Showing diffuse thickening of bilateral adrenal glands (white arrow) with ongoing stranding. Full size image Within 1 day of initiation of regular intravenous hydrocortisone 50 mg every 6 h, the hemodynamic status rapidly improved allowing the discontinuation of all vasopressors

Primary bilateral macronodular adrenal hyperplasia (PBMAH) is a highly heterogeneous entity. The incidental identification of an increasing number of cases has shifted its clinical expression from the rarely encountered severe forms, regarding both cortisol excess and adrenal enlargement, to mild forms of asymptomatic or oligosymptomatic cases with less impressive imaging phenotypes Health care providers use a variety of surgical and medical treatments for adrenal gland disorders. These include 1:. Surgery to remove tumors in the adrenal gland or, when appropriate, surgery to remove the one or both of the adrenal gland

Retroperitoneal Spaces

E27.8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM E27.8 became effective on October 1, 2020. This is the American ICD-10-CM version of E27.8 - other international versions of ICD-10 E27.8 may differ. Applicable To. Abnormality of cortisol-binding globulin A pituitary magnetic resonance imaging scan was normal. The patient was treated with potassium supplement, vasodilator, and insulin therapy. A right middle lobe (RML) lung tumor of 1.67 cm and thickening of bilateral adrenal glands were found in the subsequent chest computed tomography (CT) Adrenal carcinoma is a rare adrenal neoplasm arising from the cortex and is bilateral in 10% of patients (, 59). Fifty percent of adrenal carcinomas are functioning neoplasms with secondary sequelae from the hormone produced, such as Cushing, virilization, feminization, or Conn syndromes

What does thickening of adrenal gland mean

Hormones are important in many body processes, including metabolism, sexual development and puberty, and stress. There are two adrenal glands, one on the top of each kidney. They are shaped like triangles, and each is about ½ inch high and 3 inches long. Each gland has two parts. The medulla is the inner part of the adrenal gland Hyperplasia is defined as diffuse adrenal thickening, most often bilateral, and is usually due to hyperstimulation by excessive ACTH, which results in Cushing syndrome. Excluding exogenous hormone administration for medical purposes, Cushing syndrome is caused by ACTH overproduction in 80-85 % of cases, 85 % of which are caused by a pituitary.

Bilateral adrenal hyperplasia (BAH): generalized thickening of adrenal cortex, usually without discrete nodules Nodular adrenal hyperplasia (NAH): adrenal cortex contains multiple nodules with / without generalized thickening Various cutoffs exist for macro versus micronodular hyperplasia (range 0.5 - 3.0 cm in diameter Results showed resolved bilateral adrenal thickening and no adrenal fluorodeoxyglucose avidity . Importantly, the patient followed up with outpatient endocrine and reported no interval symptoms, resolution of fevers, and improvement in neurologic function

Methods. Thirty- four patients with primary aldosteronism were selected prospectively for adrenal venous sampling on the basis of CT findings: normal findings or minimal thickening of an adrenal limb (n = 15), unilateral microadenoma (n = 6), bilateral adrenal nodules (n = 9), or atypical unilateral adrenal macroadenoma (n = 4). Results Bilateral double J stenting was done for hydronephrosis. Surgical debulking of the lesion was done with biopsy from the left periureteral wall thickening and was found to be myelolipoma on histopathological examination. This case is a novel variety of myelolipoma which is lipid poor, extra-adrenal and in bilateral perirenal and periureteric. Chest X-ray was normal. A computed tomography (CT) of the abdomen and pelvis showed hepatic hemangiomas, bilateral adrenal thickening, and a mass in the body of the uterus. The patient underwent surgical staging by total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node dissection for International. Based on the results of opposed-phase chemical shift magnetic resonance imaging (MRI), the adenomas displayed bilateral adrenal thickening with multiple nodules, in which the right nodule was approximately 12.3 × 15.5 mm and the left nodule was approximately 12.8 × 10.6 mm . Although early studies have reported that imaging techniques may be. Disorder of adrenal gland, unspecified. E27.9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM E27.9 became effective on October 1, 2020

CECT of abdomen showed bilateral diffuse thickening of adrenal glands without calcifications. CT guided biopsy of Adrenals showed granulamatous adrenalitis thus confirming the diagnosis of primary adrenal tuberculosis. DISCUSSION: PAI is caused by destruction of Adrenocortical tissue due to Autoimmume ds.,TB, Cryptococcosis, Fungal infections. Adrenal gland abnormality can vary from subtle thickening of the limbs as seen in hyperplasia, to small subcentimeter adenomatous nodules, to multiple tiny nodules of hyperplasia, to 6cm. (or more) masses. In a patient with a known malignancy, particularly in lung or breast carcinomas, the finding of bilateral adrenal masses most likely. UCLA endocrine surgeon Masha Livhits, MD, presented a live-streaming webinar to discuss an overview of adrenal hormones and their role in causing high blood pressure, when adrenal hormone levels should be checked and what are the treatment options.. When adrenal tumors make too much cortisol, this is called Cushing's syndrome. Patient with Cushing's syndrome may experience Additional CT of the chest and abdomen revealed the presence of pericardial effusion, circumferential infiltration of the thoracic aorta and its main branches (Fig. 2), symmetric soft-tissue infiltration of the perirenal fat, with the presence of hairy kidneys, and bilateral adrenal enlargement (Fig 3.)

Adrenal Hyperplasia - an overview ScienceDirect Topic

What does nodular thickening of the left adrenal gland likely representing adenomatous hyperplasia mean? - Answered by a verified Oncologist Left adrenal mass loses signal on out of phase imaging and is therefore felt to represent a benign adenoma. Nevertheless I would perform follow-up studies to document stability METHODS: Thirty-four patients with primary aldosteronism were selected prospectively for adrenal venous sampling on the basis of CT findings: normal findings or minimal thickening of an adrenal limb (n = 15), unilateral microadenoma (n = 6), bilateral adrenal nodules (n = 9), or atypical unilateral adrenal macroadenoma (n = 4) Adrenal tuberculosis is also reported to cause bilateral adrenal involvement with peripheral rim enhancement. [ 13 - 15 ] In our study, a thin peripheral enhancing rim was noted in 50% of cases of adrenal metastasis (3/6) and in 2 cases, a thick irregular enhancing rim was noted A 64-year-old male presents with shoulder pain, arm pain, and a chronic cough. CT imaging of the thorax shows a large 8.0 x 6.7 cm mass with central necrosis in the left upper lung lobe with invasion into the chest wall with partial destruction of the second and third ribs, and left axillary adenopathy. Bilateral adrenal nodules are identified via CT imaging and subsequently biopsied hyperplasia [hi″per-pla´zhah] abnormal increase in volume of a tissue or organ caused by the formation and growth of new normal cells. See also hypertrophy and proliferation. adj., adj hyperplas´tic. benign prostatic hyperplasia benign prostatic hypertrophy. cutaneous lymphoid hyperplasia a group of benign cutaneous disorders characterized by.

Hyperplasia of the adrenal glands Symptoms and treatment

In fact, adrenal vein thrombosis was adrenal hemorrhage, which demonstrated features of identified in 33 of 78 cases of adrenal hemorrhage in a preceding adrenal congestion (adrenal gland thickening pathological study by Fox [7]. and peri-adrenal fat stranding) on computed tomogra- As implicated by the above risk factors, non-trau- phy (CT. Millones de Productos que Comprar! Envío Gratis en Pedidos desde $59 Bilateral adrenal-renal fusion: A radiological diagnosis Case report. Bilateral adrenal-renal fusion: A radiological diagnosis He was thought to have prostatism and was referred for a pelvic MRI, which showed thickening of the bladder wall. Cystoscopy and bladder biopsy confirmed the presence of a mostly papillary but partly solid high. Irrelevant family history. After right hemicolectomy for a colon polyp with high-grade dysplasia she performed a CT scan which showed nodular thickening of the adrenal glands with bilateral hypodense nodules, the largest in the right adrenal gland with 32 mm and in the left with 31 mm. She was referred to the Endocrinology appointment

Introduction: Bilateral adrenal mass presents a unique diagnostic challenge and carries additional risk of being metastasis. The differential diagnosis of bilateral adrenal mass include primary or secondary neoplastic disorders (adrenocortical carcinoma, lymphoma, metastases), pheochromocytoma, longstanding congenital adrenal hyperplasia and macronodular adrenal hyperplasia, infections such as. Adrenal Insufficiency (Addison's Disease) Adrenal insufficiency occurs when the adrenal glands don't make enough of the hormone cortisol. You have two adrenal glands. They are located just above the kidneys. They work with the hypothalamus and pituitary glands in the brain. Cortisol helps break down fats, proteins, and carbohydrates in your body Adrenal cancer occurs when cancerous cells form in an adrenal gland, located above the kidney. Find out what symptoms to watch for, and how the disease is diagnosed and treated

Adrenal Mass: Symptoms, Diagnosis & Treatment - Urology

revealed bilateral thickening of the adrenal cortex with irregular nodular conversion, consistent with PBAD. Substitution therapy was initiated with hydro-GNAS mutation and bilateral adrenal hyperplasia 449 cortisone and fludrocortisone. At the age of 4 months, the patient developed signs of peripheral precocious puberty; an ovarian cyst on the. Abdominal CT scan showed thickening and nodularity of both adrenal glands with a maximum size of 10.75x6.79 mm in the right adrenal with an HU of 2 and 15.58x12.38 mm in the left adrenal with HU of 7 (Figure 1). In a retrospective analysis of the first abdominal CT scan in 2014, there was the enlargement of both adrenal glands which was not.

What are the symptoms of adrenal gland disorders? NICHD

The imaging findings are wide, from oval masses to ill-defined soft-tissue stranding around the adrenal gland (infiltration of blood through the retroperitoneal fat) and thickening of adrenal glands. [4 A CT scan was done to look for a source of sepsis, but the cause of the patient's symptoms was bilateral adrenal hemorrhage. The patient was in an addisonian crisis. If the diagnosis had not been. Adrenal Adenoma is a pathological condition of the adrenal glands in which there is development of benign tumors in the adrenal glands. The front line treatment for Adrenal Adenoma is surgery. The surgical procedure done for removal of Adrenal Adenoma is called as adrenalectomy. Know the causes, symptoms, treatment and prognosis of adrenal adenoma abdomen and pelvis showed hepatic hemangiomas, bilateral adrenal thickening, and a mass in the body of the uterus. e patient underwent surgical staging by total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymph node dissection for International Fed J.M. Willhite Bilateral ovarian cysts are independent sacs of fluid that form on both ovaries simultaneously. Bilateral ovarian cysts are independent sacs of fluid that form on both ovaries at the same time. Considered a rare medical condition that can necessitate surgery, these ovarian cysts can cause a variety of signs and symptoms prior to their detection

Myelofibrosis CT - wikidocImaging of Nonmalignant Adrenal Lesions in ChildrenRadiologySpirit: 2010-04-25Gastric Carcinoma Imaging: Overview, Radiography, Computed

Benign adrenal tumors - Symptoms and causes - Mayo Clini

An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, serendipitously discovered by radiologic examination [ 1 ]. This entity is the result of technological advances in imaging such as computed tomography (CT) and magnetic resonance imaging (MRI) and their widespread use in clinical practice Most adrenal masses are detected first on abdominal CT scans, with an incidence of 0.6 to 1.3 percent on such scans.11 The vast majority of asymptomatic adrenal masses are benign, and patients. Adrenal gland cancers are extremely rare, and can lead to high levels of any of the many adrenal hormones. A wide variety of symptoms are possible, so evaluation by an endocrinologist is important. Generally, surgical intervention and chemotherapy are used to treat the cancer.Subsequent hormone therapy may also be necessary

Bilateral adrenal hyperplasia is best treated medicall

Traumatic bilateral adrenal injuries are uncommon. Adrenal injuries are overall associated with worse outcome than non-adrenal injuries. However, direct comparative evidence between unilateral and bilateral adrenal injuries is unavailable in literature. This study aims to investigate clinical significance of bilateral adrenal hematomas in terms of injury severity, morbidity and mortality An adrenal incidentaloma is now established as a common endocrine diagnosis that requires a multidisciplinary approach for effective management. The majority of patients can be reassured and discharged, but a personalized approach based upon image analysis, endocrine workup, and clinical symptoms and signs are required in every case Patients with IHA have bilateral thickening and variable nodularity of their adrenal cortex. A wide spectrum of severity exists for this disorder, which may go undetected for long periods with no hypokalemia and only mild hypertension. It has been suggested that IHA arises as a result of an undetected adrenal cortex-stimulating factor

Symptoms Most adrenocortical cancers are found after they have been growing for years. Fewer than 30% of adrenocortical cancers are confined to the adrenal gland at the time of diagnosis. The most common symptom reported by patients with adrenocortical cancer is pain in the back or side (called the flank). Unfortunately, this type of pain is common and does not directly suggest a disease of. Characteristics of Adrenal Cortical Cancer. Typically an aggressive cancer. Most (~60%) are found because excess hormone production causes symptoms which prompt patients to seek medical attention. Most (60-80%) actually secrete high amounts of one or more adrenal hormones. Many will present with pain in the abdomen and flank (nearly all that. A thickening of the bladder wall can be a sign of several medical conditions. It's usually accompanied by other symptoms, too. It's usually accompanied by other symptoms, too

This is the first report in literature of bilateral adrenal and liver secondaries after potentially curative gastrectomy and adjuvant chemotherapy. The patient has a disease free survival of 1.5 years with the adjuvant chemotherapy with overall survival of three years with erlotinib and capecitabine as a second line chemotherapy Adrenal incidentalomas are common and seen in about 3% of abdominal CT's, increasing up to 10% in elderly patients [1,2,3].The issue is to differentiate benign adrenal tumors from metastases or primary malignant masses without unnecessarily exposing the majority of patients to the burden of clinical workup, interventions and imaging follow-up Based on the results of opposed-phase chemical shift magnetic resonance imaging (MRI), the adenomas displayed bilateral adrenal thickening with multiple nodules, in which the right nodule was approximately 12.3 × 15.5 mm and the left nodule was approximately 12.8 × 10.6 mm (Fig. (Fig.2). 2). Although early studies have reported that imaging. Patient B showed 1 cm-sized bilateral adrenal nodules; the right nodule was suggestive for adrenal adenoma and the left nodule was indeterminate due to insufficient washout. Patient C showed normal CT finding in the right gland and 6 mm-sized thickening of medial limb of the left gland, which was suspicious for adrenal adenoma. 18F-FDG PET/CT. Adrenal medullary hyperplasia - usually bilateral, can be diffuse or nodular (nodules must be <1cm, if greater then Dx phaeochromocytoma) - iffuse thickening of medulla and expansion into tail of gland +/- nodule formation, with an increased medulla-to-cortex ratio, enlarged cells +/- pleomorphism and increased mitotic activity, hyaline golbules common in MEN In the left adrenal gland, three yellow-orange, circumscribed nodules, measuring up to 1.4, 1.5, and 2.8 cm, respectively, dominated the specimen . The remaining cortex of both adrenal glands displayed diffuse thickening with faint nodularity