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Date of last update: 10/17/2017.

Forum Name: Endocrinology Topics

Question: Diffuse Fullness of Left Adrenal Gland

 team468 - Wed Dec 09, 2009 8:48 pm

I had an attack of acute pancreatitis on 8/30/09. The cause was not found. I'm still experiencing stomach pain and I had a MRI recently. This showed diffuse fullness of left adrenal gland with intense signal drop out. No lesion was seen. What does this mean and what could cause this? I should mention that I had some mildly enlarged lymph nodes in my retroperitoneum measuring up to 1.5 cm.

 Dr.M.Aroon kamath - Mon Dec 14, 2009 8:38 pm

User avatar Hi,
Of late, thanks to the advanced imaging techniques, it is being recognized that the adrenals may be involved in cases of acute pancreatitis and also that they may affect the severity of the pancreatitis as well as prognosis.

Changes in the adrenals have beeen reported in some cases of acute pancreatitis on CT and MRI (adrenal enlargement, hyper-attenuation as well as hypo-attenuation), depending upon the time-frame since onset of acute pancreatitis.

Unilateral as well as bilateral changes have been observed.

These changes are thought to be due to adrenal hemorrhage.

Why hemorrhage should occur and why the adrenals seem to be vulnerable is not yet clear.One hypothesis is listed below...

The head of the pancreas lies close to the right adrenal gland, and the tail lies in front of the left adrenal gland. Pancreas is closely related to both kidneys.Thus, pancreatic inflammation can involve the perirenal spaces.
The exudate which is rich in proteolytic enzymes,cytokines and other inflammatory mediators can penetrate Gerota's fascia and, therefore, come into contact with the adrenal glands themselves.

The precise mechanism by which the pancreatic exudate causes adrenal haemorrhage is not known. The mechanism may not be due to direct involvement. The adrenal gland has a complex arterial supply, in contrast to its limited venous drainage which is critically dependent on a single vein. This pattern of blood supply has been described as a ‘vascular dam’.

In situations of severe stress (e.g. pancreatitis), adrenocorticotropic hormone(ACTH) secretion increases, which stimulates adrenal arterial blood flow that may overwhelm the limited venous drainage capacity of the organ, leading to infarction and haemorrhage.

Even bilateral adrenal hemorrhage often does not result in adrenal hypofunction, as atleast 90% of the adrenal cortex needs to be destroyed before adrenal insuffiency occurs.

Thus unilateral adrenal involvement in acute pancreatitis may not result in any overt adrenal insuffiency, but its relationship to overall prognosis in acute pancreatitis is being studied.

I am not sure what caused the lymph nodes in your case. You need a thorough clinical examination and work- up.

Hope this information may be useful to you.
Best wishes!

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