Related Experiment Video
Updated: May 5, 2026

Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
Bilateral macronodular adrenocortical disease: a single centre experience
Background:
Data on bilateral macronodular adrenocortical disease (BMAD) with respect to computed tomography (CT) scan characteristics (attenuation and washout) and long-term follow-up are limited. This study aims to describe BMAD patients managed in a single centre.
Methods:
BMAD was defined by the presence of bilateral adrenal macronodules (>1 cm) on CT. Clinical, biochemical, radiological, genetic characteristics, management and follow-up of 22 BMAD patients were studied retrospectively.
Results:
The median age (range) at presentation was 49.5 (23-83) years, predominantly observed in females (16/22). Eighteen (82%) patients were incidentally diagnosed (11 with mild autonomous cortisol secretion (MACS) and seven non-secretory), three (13.7%) presented with overt Cushing's syndrome (CS), and one (4.5%) had androgen excess (without CS features). On CT, the dominant nodule's median (range) size was 2.6(1.6-9.5) cm. 77.8% (14/18) of adrenal nodules were lipid-rich, and 93.3% (14/15) of the nodules exhibited good washout. Genetic analysis was available for eight patients; one had a novel germline ARMC5 variant, and two had MEN-1 gene mutations. Three overt CS and one androgen-secreting patient underwent total bilateral adrenalectomy; histopathology showed macronodular hyperplasia with internodular hypertrophy. Only one (1/8) patient from the MACS group developed a new comorbidity (diabetes mellitus) after a median follow-up of 6.4 (0.5-12.4) years, while none of the non-secretory group patients developed new comorbidities after a median follow-up of 1.4 (0.8-12.2) years.
Conclusion:
Most BMAD patients presented without overt hormonal excess, and none developed overt CS on follow-up. Detailed CT characteristics of BMAD nodules may help in radiological diagnosis in bilateral adrenal incidentalomas.
Related Concept Videos
Anatomy of the Adrenal Glands
These glands possess a distinctive yellow tinge due to the stored cholesterol and fatty acids required for hormone synthesis. They are encased in a fibrous capsule and cushioned by fat.
The adrenal gland comprises two distinct...
Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Nephrotic Syndrome I : Introduction
Nephrotic Syndrome II : Assessment and Medical Management
Cushing Syndrome I: Introduction
Cushing Syndrome II: Pathophysiology

