 Benign neoplasm arising from adrenal cortical cells

 May or may not be functiona

 When functional may secrete one/more of the 3 major classes of adrenal steroids (from external
to internal layers):

 Zona glomerulosa: mineralocorticoids (aldosterone)

 Zona fasciculata: glucocorticoids (cortisol)
 Zona reticularis: androgens (testosterone, dihydrotestosterone [DHT], androstenedione,
dihydroepiandosterone [DHEA])
 Hyperaldosteronism/Conn’s syndrome: ↑aldosterone → impacts distal tubules &
collecting ducts of nephron → ↑ sodium and water retention, ↓ potassium retention → ↑
blood pressure
 Hypercortisolism/Cushing’s syndrome: ↑cortisol → ↓ corticotropin releasing hormone
(CRH), ↓ adrenocorticotropic hormone (ACTH), ↑ blood glucose
 Virilization: ↑ DHEA, ↑ DHEA-sulfate (DHEA-S), ↑ androstenedione, ↑ testosterone, ↑
DHT → ↑ urinary 17-ketosteroids (metabolic product)
 Feminization: ↑ androgens → aromatization → ↑ estrogen, ↑ estradiol → ↑ urinary 17-
ketosteroids (metabolic product)

 Minority are functional, may produce a pure or mixed endocrine syndrome (from most to
least common):
 Hyperaldosteronism/Conn’s syndrome: hypertension, proximal muscle weakness,
headache, polyuria, tachycardia with/without palpitation, hypokalemia, hypocalcemia
 Hypercortisolism/Cushing’s syndrome: central obesity, moon facies, plethora, striae,
thin skin, easy bruising, hirsutism, telangiectasias, hyperhidrosis
 Virilization:
 Females: increased muscle mass (Herculean habitus), clitoromegaly, facial hair, deep
voice, pubic hair
 Males: penile enlargement, pubic hair
 Feminization: gynecomastia, impotence

 Well-circumscribed lesion comprised of cells resembling any of the 3 layers of the normal
adrenal cortex
 Difficult to differentiate ACA from normal adrenal cortex in adrenal core needle biopsies
 Computed tomography (CT):
 Rounded, well delineated borders, homogeneous, clear separation from and no extension
into surrounding structures, decreased attenuation compared to uninvolved adrenal
parenchyma on non-contrast CT (≤10 HU), contrast enhancing (Theranostics 2012;2:516)
 Magnetic resonance imagining (MRI):
 Used to visualize microscopic fat (favoring ACA), “chemical shift” phenomenon (increased
“in phase” signal intensity, decreased “out of phase” signal) (Theranostics 2012;2:516)
 18FDG-PET:
 Malignant lesions have greater 18FDG uptake than liver (Theranostics 2012;2:516)