Adrenal calcification

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Adrenal calcification is not a rare finding in healthy asymptomatic people and is usually the result of previous haemorrhage or tuberculosis. Addison disease patients only occasionally develop calcification.

Pathology

Aetiology

Haemorrhage

sepsis: Waterhouse-Friderichsen syndrome
blunt abdominal trauma
adrenal pseudocyst
neonatal asphyxia
coagulopathy
infants: calcification seen soon after haemorrhage (as early as 1-2 weeks)

Infection

Adrenal tumours

Others

Addison disease
- uncommon in primary Addison disease; calcification suggests an underlying cause (e.g. infection)
Wolman disease

Radiographic features

Adrenal calcification is best assessed on CT where it can be differentiated from a calcified adrenal mass or lesion. CT also allows simultaneous characterisation of any underlying lesions with size, density, enhancement, and washout.

In children, neuroblastoma has been reported as the commonest calcifying adrenal mass ⁴. In adults, simple calcified cysts have been reported as common adrenal masses, characteristically showing peripheral curvilinear calcification.

Post-haemorrhage calcification is usually seen after the initial adrenal haematoma has resolved and, hence, is not usually seen with an adrenal lesion. However, adrenal metastases such as from bronchogenic tumours can present with haemorrhage, making the diagnosis challenging.

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