Retroperitoneum
life-threatening condition caused by partial or complete failure of the adrenocortical function. Also known as adrenocortical insufficiency.
congenital disorder causing an increase in production of androgens.
uncommon condition resulting from excessive aldosterone secretions.
a metabolic disorder resulting from chronic and excessive production of cortisol by the adrenal cortex. Results in the inability of the body to regulate secretions of cortisol or adrenocorticotrophic hormone (ACTH). Also known as hyperadrenalism.
fibers that connect the vertebral column and diaphragm. They are identified superior to the celiac axis and lie anterior to the aorta and posterior to the inferior vena cava.
enlarged lymph nodes posterior to the aorta giving the impression that the aorta is floating above the spine.
excessive production of aldosterone.
focal or generalized enlargement of the lymph nodes.
malignant tumor of the adrenal gland found in young children.
rare vascular tumor of the adrenal medulla.
pertaining to organs closely attached to the posterior abdominal wall.
dense fibrous tissue proliferation typically confined to the paravertebral and central retroperitoneum areas.
Location
• Retroperitoneal structures located in Gerota’s fascia within the perinephric space.
• Located anterior, medial, and superior to each kidney.
• Lie lateral to the diaphragmatic crura.
• Right adrenal gland lies posterior and lateral to the inferior vena cava.
• Left adrenal gland lies lateral to the aorta and posterior-medial to the splenic artery and tail of the pancreas.
Vascular anatomy
• The superior, middle, and inferior suprarenal arteries supply the adrenal glands.
• Superior suprarenal artery arises from the inferior phrenic artery.
• Middle suprarenal artery arises from the lateral aspect of the abdominal aorta.
• Inferior suprarenal artery arises from the renal artery.
• Right suprarenal vein drains directly into the inferior vena cava.
Technique
Preparation
• No preparation is necessary for a sonogram of the adrenal glands or retroperitoneum.
• Nothing by mouth (NPO) 6 to 8 hours before examination for adults, 6 hours for children, and 4 hours for infants to decrease intestinal interference.
Examination technique and image optimization
• Use the highest-frequency abdominal transducer possible to obtain optimal resolution for penetration depth.
• Place gain settings to display the normal liver parenchyma as a medium shade of gray with adjustments to reduce echoes within the vessels.
• Focal zone(s) at or below the place of interest.
• Sufficient imaging depth to visualize structures immediately posterior to the region of interest.
• Harmonic imaging or decreasing system compression (dynamic range) can be used to reduce artifactual echoes within anechoic structures.
• Spatial compounding can be used to improve visualization of structures posterior to a highly attenuating structure.
• Supine, oblique, and/or decubitus positions may be used.
• Sagittal or coronal and transverse planes are used to evaluate and document the adrenal glands using surrounding anatomical landmarks.
• Documentation and measurement of the length, height, and width.
• Color Doppler imaging, using a 60-degree angle or less, to evaluate each adrenal gland visualized.
• Evaluation and documentation of the retroperitoneum using a four- or nine-quadrant method.
• Length, height, and width of visible lymph nodes, including color Doppler imaging of the hilum.
• Documentation and measurement of any abnormality in two scanning planes with and without color Doppler should be included.
Laboratory values
Adrenocorticotrophic hormone (ACTH)
• Normal range: 10 to 80 pg/mL.
• Regulates cortisol production.
• Produced in the pituitary gland.
• Elevation associated with adrenal tumor, Cushing disease, and lung tumor.
Sodium
PATHOLOGY | ETIOLOGY | CLINICAL FINDINGS | SONOGRAPHIC FINDINGS | DIFFERENTIAL CONSIDERATIONS |
Adenoma | Benign cortical massFunctioning or nonfunctioningRisk Factors: Diabetes mellitus Obesity Hypertension Older population | AsymptomaticElevated adrenal hormones | Hypoechoic, homogeneous massSmooth wall marginsMay demonstrate necrosis or hemorrhage | Adrenal hyperplasiaAdrenocortical carcinomaRenal or liver massAdrenal hemorrhage |
Adrenal cyst | RareUnilateral | AsymptomaticHypertension | Anechoic massWell-defined wall marginsPosterior acoustic enhancementWalls may calcify | Cyst of the liver, spleen, or kidneyHydronephrosis |
Adrenal hemorrhage | Adrenal massHypoxiaTraumatic deliverySepticemia | AsymptomaticPalpable abdominal massDecrease in hematocrit | Cystic or complex adrenal massFrequently located on the right | Cyst or neoplasm of the liver, spleen, or kidneyAdenomaAdrenocortical carcinoma |
Adrenal hyperplasia | Proliferation in adrenal cellsTypically bilateral | AsymptomaticHypertensionElevated adrenocorticotrophic hormone (ACTH) level | Enlargement of the adrenal gland(s)Change in the normal triangular shape | AdenomaAdrenocortical carcinoma |
Pheochromocytoma | Rare vascular tumor of the medullaSmall percentage are malignantRight-side prevalence | HypertensionSweatingTachycardiaChest or epigastric painHeadachePalpitationsSevere anxietyIncrease in epinephrine and norepinephrine | Solid massHomogeneous textureMay appear complex because of necrosis or hemorrhageMay calcifyMetastasis to liver, lymph nodes, lung, and bone if malignant | Renal massAdrenocortical carcinomaAdrenal adenomaAdrenal hemorrhage |
PATHOLOGY | ETIOLOGY | CLINICAL FINDINGS | SONOGRAPHIC FINDINGS | DIFFERENTIAL CONSIDERATIONS |
Adrenocortical carcinoma | Neoplasm of the adrenal cortexFunctioning or nonfunctioning | HypertensionWeaknessAbdominal painWeight lossWeakening of the bones | Complex or echogenic massIrregular wall marginsTends to invade the IVCMetastasis to the lungs and bone | Renal massAdrenal hemorrhagePheochromocytomaMetastases |
Metastases | Lung most commonBreastStomach | HypertensionAbdominal pain | Focal massVariable in appearance | Renal massAdrenal hemorrhagePheochromocytomaAdrenocortical carcinoma |
NeuroblastomaThird most common malignancy in infancy | Neoplasm of the adrenal gland common in young childrenMale prevalenceHalf occur before 2 years of ageMore common on the left | Palpable massAbdominal distentionSweatingWeight lossFatigueTachycardia | Heterogeneous massPoorly defined wall marginsPinpoint calcifications (30%)LymphadenopathyMass encases the aorta, inferior vena cava, superior mesenteric artery, and veinNo invasion of the renal veinMetastasis to the liver, bone, lung, and lymph nodes | NephroblastomaLymphomaAdrenal hemorrhage |
Conditions Associated with the Adrenal Glands

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CONDITION | DESCRIPTION | ETIOLOGY | CLINICAL FINDINGS |
Addison disease | Life-threatening condition caused by partial or complete failure of adrenocortical function (hypofunction)Destruction of the adrenal cortexLoss of cortisol and aldosterone secretionsIncreased incidence in femalesDiagnosis is established if the amount of cortisol in the plasma and steroid in the urine do not increase after stimulation with adrenocorticotrophic hormone (ACTH) |