Pediatric Sonography- Adrenal Glands

the adrenals are best visualized on neonates up to ______ month(s) of age

1

what hormones do the medulla of the adrenals secrete?

catecholamines, which are your epinephrine and norepinephrine

catecholamines are known for what type of response?

fight or flight

what are the 2 types of neuroblastomas that are usually benign?

Ganglioneuroblastoma

Ganglioneuroma

what is the main clinical finding in neuroblastoma?

Palpable mass

what are the signs/symptoms of neuroblastoma?

Fever

Weight loss

Irritability

Hypertention

Abdo distention

which patient demographic does neuroblastoma have a better prognosis in?

neonates and young children

older = worse prognosis

other than adrenals, where else can neuroblastomas arise from?

abdomen

pelvis

chest

neck

what is the sonographic appearance of neuroblastoma?

Echogenic mass

Poorly defined borders

Calcifications with PAS

Areas of necrosis (hypoechoic)

Displaced kidney

Mets - often at presentation

what are the signs/symptoms of adrenocortical carcinoma?

Virilizing symptoms

Abdo mass

Deepened voice

Hypertention

Seizures

what is the sonographic appearance of adrenocortical carcinoma?

Echogenic

Complex/heterogenous - from necrosis and hemorrhage

May have:

Thick echogenic capsule

Calcifications

what is a rare functioning tumour in the adrenal medulla that causes high BP?

pheochromocytoma

what are the clinical presentations of pheochromocytoma?

↑ BP

Headache

Palpitations

Diaphoresis

what is the sonographic appearance of pheochromocytoma?

Solid

Mixed - solid and cystic

Cystic

Large lesions have hemorrhage and necrosis

Almost always - sharply encapsulated

what are the causes of adrenal hemorrhage? (3)

Prematurity

Neonatal sepsis or hypoxia

Birth trauma

what are the clinical presentations of adrenal hemorrhage?

Palpable mass

Anemia

Jaundice (resorption of excess Hb)

↓ BP

what is a unique clinical finding of adrenal hemorrhage in boys only?

scrotal discoloration

what is the sonographic appearance of an adrenal hemorrhage?

Echogenic mass

Anechoic if liquefies

Follow up scans to see change and establish Dx

In a few weeks or months Ca2+ appear

are adrenal cysts common?

no

what is the sonographic appearance of adrenal cysts?

Anechoic

Well-defined walls

Enhancement

Displace the kidney inferiorly

Can contain debris

Must be distinguished from renal cysts, hydronephrosis, splenic and pancreatic cysts

what is an autosomal-recessive condition caused by an enzyme deficiency in the adrenal cortex and accumulation of androgenic precursors?

congenital adrenal hyperplasia

how is congenital adrenal hyperplasia diagnosed?

biochemical testing

what is the sonographic appearance of congenital adrenal hyperplasia?

Increased adrenal size

Enlargement involves mostly the cortex

Preserved sonographic appearance

Cerebriform appearance

Length > 20mm, Width > 4mm

what is the sonographic sign of the adrenal glands with renal agenesis?

lying flat adrenals