Table 2

Clinical, biochemical and radiological features of adrenal Cushing

Primary adrenocortical hyperplasia
Macronodular hyperplasiaMicronodular hyperplasia
Adrenocortical adenomaAdrenocortical carcinomaBMAHc-BMAHPPNADMAD
Frequency∼55%∼35%Estimated 10%
AgeAll agesAll ages; familial cases in childhoodFifth to sixth decadeEarly childhoodChildhood or early adulthood
Clinical presentationMild-to-severe CushingModerate-to-severe Cushing with rapid onset and possible virilisationMild Cushing with insidious onsetModerate-to-severe CushingModerate-to-severe Cushing
Biochemical featuresNegative Liddle's testNegative Liddle's testNegative Liddle's testNegative Liddle's testParadoxical cortisol response in Liddle's testNegative Liddle's test
Radiological featuresSolitary mass, often <4 cm, defined margins, homogeneous, <10 HFU, absolute washout >60%Solitary mass, often >4 cm, irregular margins, heterogenous, >10 HFU, absolute washout <60%Marked bilateral adrenal enlargement with multiple large non-pigmented nodules (1–5 cm)Normal or small size adrenal glands with occasional small nodules (<1 cm)
  • BMAH, primary bilateral macronodular adrenocortical hyperplasia; c-BMAH, childhood BMAH; HFU, Hounsfield unit; MAD, non-pigmented micronodular adrenocortical disease; PPNAD, primary pigmented nodular adrenocortical disease.