Black (or Brown) Adrenal Cortical Adenoma: Its Characteristic Features on Computed Tomography and Endocrine Data

Abstract

Seventeen patients with adrenal adenoma causing Cushing's syndrome, eight patients with Cushing's disease due to hypersecretion of ACTH, and five patients with primary aldosteronism due to an aldosteronoma were studied for their computed tomographic (CT) patterns, hormonal profiles, and macroscopic and microscopic findings of the adrenal gland. Black (or brown) adrenal adenomas were found in 71% of the patients with Cushing's syndrome, but not in patients with aldosteronoma. The adrenal tissue of patients with Cushing's disease was predominantly yellow. The number of compact cells was larger in black or brown adenomas than in yellow tumors or hyperplastic adrenal tissue. In patients with Cushing's syndrome, urinary excretion of 17-ketosteroids (17-KS) and serum aldosterone concentrations were lower in those with black or brown adenomas than in those with yellow adenomas (P less than 0.05). Patients with Cushing's disease had even higher 17-KS and serum aldosterone levels. No difference was found in serum cortisol concentrations and dexamethasone suppressibility in two types of adenomas causing Cushing's syndrome. Visual estimation of radiological density of the adrenal tissue relative to the kidney on CT scan and quantitative measurement of it by CT number revealed a difference between the two types of adrenal tumors causing Cushing's syndrome. Adrenal tumors with decreased density on CT scan were yellow adenomas with predominantly clear cells, and those with equal or increased density were black or brown adenomas with predominantly compact cells. All aldosteronomas had decreased density and consisted of clear cells. It is suggested that black or brown adenomas of the adrenal gland have higher radiological density and accompanying lower serum aldosterone and urinary 17-KS levels than ordinary yellow tumors. The abundance of compact cells may have some significance for the development of this particular type of adrenal tumor.

Analysis of Adrenocortical Hyperplasia by Computed Tomography in Patients with Cushing's Disease, Idiopathic Hyperaldosteronism and Adrenogenital Syndrome.

“…The control group consists of 82 normal subjects (36 males and 46 females), 13 patients with Cushing's syndrome due to adrenal adenoma (2 males and 11 females), 7 [17 , 18] and the lack of CT evidence of an adrenal tumor [3,6]. An adrenal tumor was diagnosed on the basis of unilateral accumulation of radioactive cholesterol [18] and CT evidence of an adrenal tumor [2,4,5,7].…”

“…CT scans reveal adenomatous changes in the adrenal glands in patients with excess glucocorticoid or mineralocorticoid [2][3][4][5][6][7] and, when used in conjunction with the analytical method described by Montagne et a1., permit the accurate quantitation of width, length and thickness of the glands [8]. We evaluated CT changes in the adrenal glands in patients with Cushing's disease [9], idiopathic hyperaldosteronism (IHA) [10] and adrenogenital syndrome (AGS) [11] to assess the usefulness of the CT scan in the diagnosis of adrenal hyperplasia.…”

Preclinical Cushing's Syndrome Resulting from Adrenal Black Adenoma Diagnosed with Diabetic Ketoacidosis

“…However, there were no significant differences in serum cortisol concentrations or dexamethasone suppressibility in patients with either type of adrenal adenoma [18,19], and the cortisol composition of black adrenal adenoma was not higher than that of yellow adrenal adenoma.…”

“…Komiya et al reported that the number of compact cells was higher in black adenoma than in yellow adenoma, and this difference may reflect quantitative alterations in lipid content or qualitative differences in lipids within the cells [18]. However, there were no significant differences in serum cortisol concentrations or dexamethasone suppressibility in patients with either type of adrenal adenoma [18,19], and the cortisol composition of black adrenal adenoma was not higher than that of yellow adrenal adenoma.…”

A New Variant of 17.ALPHA.-Hydroxylase Deficiency with Hyperaldosteronism in Two Japanese Sisters.

“…Urinary aldosterone was measured by ALDOSTERONE RIAKIT (Dainabot Co.) after hydrolysis at pH 1 for 24 h. Urinary 17-hydroxy steroids (17-OHCS) and 17-ketosteroids (17-KS) were measured as reported previously (Komiya et al, 1985). Urinary pregnanediol and pregnanetriol were determined by gaschromatography (Funao et al, 1972).…”