Adrenal hiperplazi

Özet

Adrenal hiperplazi, korteksin diffüz veya nodüler büyümesi olarak görülebilir ve konjenital adrenal hiperplazi (CAH) sıklıkla bu morfolojik değişikliğe yol açar. BT’de bezin iki kolu boyunca yaygın kalınlaşma, bez biçiminin korunması veya nodüler dönüşümün dağılımı tanımaya yardım eder. Geleneksel Y/V biçiminin korunması, bilateral veya çoklu nodüler tutulum ve komşu adrenal dokunun değerlendirilmesi, diffüz/hyperplastik süreçleri fokal tümörlerden ayırt etmeye yardımcı olur. Hiperplaziye eşlik edebilen hormonal fazlalık BT ile ölçülemez; normal boyutlu bezde mikronodüller de BT’de görünmeyebilir.

Faz ve pencere

Kontrastsız tanısal

Adrenal bezlerin boyutu, kol kalınlığı ve Y/V konturunun korunup korunmadığı morfolojik olarak değerlendirilir; bu değerlendirmede standart protokol kullanımı yaygındır.

Portal

Mevcut kontrastlı BT’de bezler ve eşlik eden abdominal bulgular görülür; kontrastlanma hormonal aktiviteyi göstermez.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Diffüz hiperplazi çoğunlukla iki taraflı, düzgün ve yaygın bez büyümesiyle birlikte Y/V biçimli adreniform konturu korur.
• Makronodüler hiperplazide bezin yapısında düzensizlik ve bir veya birden fazla nodüler alan izlenebilir.
• Konjenital adrenal hiperplazide tutulum genellikle iki taraflı olduğundan her iki bez de değerlendirilir.
• Büyük nodüller normal adrenal biçimini bozup fokal tümörü taklit edebilir; bez kolu boyunca devamlılık araştırılır.
• Konjenital adrenal hiperplazide bezler büyümüş veya nodüler olabilir; eşlik eden adrenal miyelolipom da aranabilir.
• BT morfolojik büyümeyi gösterir; hormon salgısının türünü veya şiddetini belirlemez.

Ölçütler ve sınıflamalar

BT’de adrenal kortikal hiperplazi morfolojik paternleri

Diffüz patern düzgün yaygın büyüme ve korunmuş adreniform konturla; nodüler patern bez içinde bir veya daha çok kortikal nodülle tanımlanır. Tek/iki taraflı dağılım da tarif edilir. Bunlar BT morfoloji tanımlarıdır; hormonal işlevi veya güncel WHO endokrinopatolojik alt tipini tek başına belirlemez.

Normalde

Normal sağ adrenal bez aorta ile sol böbrek üst kutbu yakınında Y biçimli, sol bez vena kava inferior ile karaciğer arasında V biçimli ince bir yapıdır; kolları çevre yağdan ayrılır.

Ayırıcı tanı

Adrenokortikal adenom, iyi sınırlı bağımsız fokal bir kitledir ve hiperplaziden farklıdır.

Adrenokortikal karsinom

infiltratif kontur, heterojenite, nekroz veya damar/komşu organ invazyonu daha kuşkuludur.

Bilateral adrenal metastaz

bezleri nodüler büyütebilir; bilinen primer kanser ve ayrı yuvarlak lezyonlar ayırıcıdır.

Lenfoma

bilateral hacimli yumuşak doku kitleleri ve retroperitoneal lenfadenopati eşlik edebilir.

Konjenital adrenal hiperplazi

morfoloji hiperplaziye benzeyebilir; klinik/laboratuvar ve eşlik eden adrenal miyelolipom bağlam sağlar.

Tuzaklar

• Koronal planlama adrenal bezlerin orientasyonu ve cerebriform morfolojinin değerlendirilmesinde yardımcı olur.
• Normal adrenal bezler düzgün konturludur ve komşu abdominal organlardan retroperitoneal yağ ile ayrılır.
• Mikronodüler adrenokortikal hiperplazi, adrenal görüntülemede morfolojik olarak normal bezlerle seydebilir; bu nedenle normal görüntüleme bulgusu hastalığı dışlatmaz.
• Unilateral aldosterone-secreting adenoma, bilateral adrenal hyperplasia'dan farklı olarak tek taraflı bir lezyon ile karakterizedir.

Kendini dene

1. İki adrenal bez düzgün biçimde kalın, dallanan konturlarını koruyor ve benzer görünüyor. En uygun morfolojik tanım hangisidir?

   • Diffüz kortikal hiperplazi
   • Tek taraflı adenom
   • Adrenal miyelolipom
   • Adrenal kist
   Cevabı göster

   Diffüz kortikal hiperplazi. Bilateral düzgün büyüme ve korunmuş adreniform biçim diffüz hiperplaziyi destekler. Adenom fokal kitle, miyelolipom makroskopik yağ içeren kitle, kist ise sıvı içerikli oluşumdur.

2. Adrenal bezde düzgün olmayan büyümeye ek olarak bez yapısında nodüler alanlar izleniyor. Bu bulgu hangi paterni düşündürür?

   • Nodüler hiperplazi
   • Diffüz atrofi
   • Basit adrenal kist
   • Makroskopik yağlı kitle
   Cevabı göster

   Nodüler hiperplazi. Adrenal bezde nodüler yapılar ve düzensiz büyüme nodüler hiperplazi ile uyumludur. Atrofi bez hacminde azalma, kist sıvı içeriği, miyelolipom ise makroskopik yağ dokusunu ifade eder.

İlgili konular

• Adrenal insidentaloma: BT’de karakterizasyon çerçevesi
• Adrenal miyelolipom

Kaynaklar

Bu sayfadaki 40 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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