Nilo A. Avila MD, Presenter: Nothing to Disclose

Gabriela Finkeilstain, Abstract Co-Author: Nothing to Disclose

Andrew J. Dwyer MD, Abstract Co-Author: Nothing to Disclose

Carol Vanryzin, Abstract Co-Author: Nothing to Disclose

Reem Hanna, Abstract Co-Author: Nothing to Disclose

David Williams, Abstract Co-Author: Nothing to Disclose

Deborah Merke, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

To evaluate the frequency, CT and MR features of adrenal myelolipomas (AMLP) in patients with CAH, and their relation with hormonal profiles.

28 adult patients (19—57 years, mean 34 years) with CAH had CT or MR of the adrenal glands. The overall sizes and shapes of the adrenals were evaluated along with the frequency, size and distribution of fatty masses, characteristic of AMLP. The hormonal profiles (17-OHP, ACTH, and androstenedione levels) of patients with AMLP were compared with those of the patients without AMLP. Also total adrenal volume and adrenal volume minus the volume of AMLP were correlated with hormone levels. 

Seven/28 (25%) patients had AMLP; significantly higher than the reported 0.08-0.25% in the general population (p<0.001, Binomial Test). There were a total of 28 AMLP; size range 0.15 to 11 cm, mean 1.8 cm. The masses were: single in 3/7 (43%); multiple in 4/7 (57%); unilateral in 4/7 (57%); bilateral in 3/7 (43%). On CT, the attenuation measurements ranged from -11 to -91 HU; on MR, they had increased intensity on T1 and T2 images and decreased intensity on fat suppressed T2 images. In the 7 patients with AMLP, the adrenal glands were otherwise: normal in 4, hypertrophied in 1, and hypertrophied with nodules in 2. Mean hormone levels were not statistically significant between patients with and without AMLP (Student T test; P>0.18). In both groups of patients (with and without AMLP), total adrenal volumes were correlated with hormone levels (R>=0.49). In patients with AMLP, the volume of the fatty masses was correlated with the ACTH levels (R=0.66); the three patients with the largest AMLPs had history of non-compliance to glucocorticoid therapy. Patients with AMLP were significantly older than patients without AMLP (44 +/- 16 vs. 33 +/- 16, p= 0.05).

There is a marked increased in the frequency of AMLP in patients with CAH relative to the general population; correlation of AMLP volumes and ACTH levels suggest this may be due to metaplasia of adrenocortical cells and chronic long-term ACTH elevation.  

CAH and other conditions with elevated ACTH should be included in the differential diagnosis of AMLP.

Avila, N, Finkeilstain, G, Dwyer, A, Vanryzin, C, Hanna, R, Williams, D, Merke, D, et al, 0, Adrenal Myelolipomas in Patients with Congenital Adrenal Hyperplasia (CAH): CT and MR Findings, Frequency, and Correlation with Volume Measurements and Hormonal Profile.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8004011.html