Application of a new ultrasound criterion for the diagnosis of polycystic ovary syndrome.

Objective: To define which ultrasound criteria could replace the classic Rotterdam criteria as the best indicator of the risk of developing endocrine-metabolic changes in women with polycystic ovary syndrome (PCOS). Materials and methods: This multicenter cross-sectional study included 200 women with PCOS and one control group of 111 women without PCOS. The primary outcomes to be considered were follicular count, hirsutism, total testosterone levels, free androgen index (FAI), and insulin sensitivity (HOMA-IR), and the secondary outcome was the anti-Müllerian hormone (AMH) level. Results: The main finding in this study points toward a different ultrasound criterion-23 or more follicles of any size in at least one ovary, which is postulated as an alternative to the classic criterion described in the Rotterdam consensus. This criterion correlates better with the other two PCOS criteria and also identifies women at increased risk of hirsutism (Ferriman-Gallwey score: 6.08 ± 3.54 vs. 4.44 ± 3.75, p < 0.0001), total testosterone levels (2.24 ± 0.298 vs. 1.42 ± 1.530, p = 0.0001), FAI (4.85 ± 0.83 vs. 2.12 ± 1.93, p < 0.001), and insulin resistance (HOMA-IR: 1.74 ± 0.182 vs. 1.504 ± 0.230, p = 0.001) more accurately. Regarding AMH, large differences in their mean values were observed between the groups (7.07 vs. 4.846 ng/ml, p = 0.000). However, these differences depended on age. Conclusion: The ovarian ultrasound examination with 23 or more follicles of any size in any of the ovaries constitutes a powerful tool to accurately diagnose PCOS and to associate it with metabolic-endocrine processes such as hyperandrogenism and insulin resistance.

Long-term treatment with α-lipoic acid and myo-inositol positively affects clinical and metabolic features of polycystic ovary syndrome.

The aim of this retrospective study was to evaluate the effects of a long-term treatment with α-lipoic acid (ALA) combined with myo-inositol (MI) on clinical and metabolic features of women with polycystic ovary syndrome (PCOS). Fifty-seven women with PCOS and a history of oligoamenorrhea were treated with MI and ALA (800 mg + 2000 mg per day). Forty-four of them had complete clinical charts and were considered eligible for the study. Information about cycle length and body mass index (BMI) was checked after 6, 12, and 24 months. After 12 months ovarian volume, total testosterone plasma levels and changes in hirsutism were also evaluated. The metabolic parameters were evaluated in 16 women after 6 and 18 months of the treatment. Cycle length was significantly reduced at 6 (p < .001), 12, and 24 months of treatment (p < .01). BMI showed a reduction only at 6 months (p < .05), thereafter returning similar to the basal values. No changes of testosterone and ovarian volume were observed. HOMA-IR and fasting insulin were unchanged, but the insulin response to a 3 h OGTT was improved after 6 (p < .01) and 18 months (p < .05) of treatment. No individual suffered from any adverse event. In conclusion, the combination of ALA and MI showed to be useful as long-term therapy in PCOS women, providing a normalization of the menstrual cycle and an amelioration of insulin levels with a high tolerability.

Melatonin Treatment May Be Able to Restore Menstrual Cyclicity in Women With PCOS: A Pilot Study.

The objective of the study was to investigate the effects of 6 months of melatonin administration on clinical, endocrine, and metabolic features of women affected by polycystic ovary syndrome (PCOS). This is a prospective cohort study including 40 normal-weight women with PCOS between January and September 2016, enrolled in an academic research environment. Ultrasonographic pelvic examinations, hirsutism score evaluation, hormonal profile assays, oral glucose tolerance test, and lipid profile at baseline and after 6 months of melatonin administration were performed. Melatonin treatment significantly decreased androgens levels (free androgen index: P < .05; testosterone: P < .01; 17 hydroxyprogesterone: P < .01). Follicle-stimulating hormone levels significantly raised ( P < .01), and anti-Mullerian hormone serum levels significantly dropped after 6 months of melatonin treatment ( P < .01). No significant changes occurred in glucoinsulinemic and lipid parameters after treatment except a significant decrease of low-density lipoprotein cholesterol. Almost 95% of participants experienced an amelioration of menstrual cycles. Until now, only few data have been published about the role of melatonin in women with PCOS. This is the first study focused on the effects of exogenous oral melatonin administration on the clinical, endocrine, and metabolic characteristics of patients with PCOS. After 6 months of treatment, melatonin seems to improve menstrual irregularities and biochemical hyperandrogenism in women with PCOS through a direct, insulin-independent effect on the ovary. Based on our results, melatonin could be considered a potential future therapeutic agent for women affected by PCOS.

The evaluation of endothelial function and structure in hirsute patients in reproductive age.

OBJECTIVE: To evaluate the endothelial function and structure in patients with hirsutism in reproductive age. STUDY DESIGN: The study was conducted on 69 consecutive women admitted with complaints of hirsutism and 63 voluntary healthy women, as controls. A total of 132 subjects who applied to the Gynecology and Infertility Outpatient Clinics were included. Participants with modified Ferriman Gallway (mFG) score over 8 were considered to be hirsute. The demographic, metabolic, hormonal characteristics, risk factors of cardiovascular disease, CIMT (carotis intima media thickness) and FMD (flow-mediated dilatation) were compared between hirsute women and those in the control group. A prospective case-control study was performed. RESULTS: There was no statistically significant difference in CIMT (0,50±0,08 vs 0,52±0,08, p=0.38) and FMD (10,80±6,83 vs 9,57±6,52, p=0.34) values between the study and control groups, respectively. There was no statistically significant correleation between CIMT and FMD values with age, body mass index (BMI), waist circumference, hip circumference, waist/hip ratio, CRP (C-reactive protein), total cholesterol, LDL (low density lipoprotein), HDL (high density lipoprotein), total testosteron, FAI (free androjen index), androstenedion, SHBG (sex hormone binding globuline), DHEA-S, hirsutism score, sistolic blood pressure, diastolic blood pressure, HOMA-IR (homeostatic model of assesment insuline resistance) value. CONCLUSION: The effect of the presence of hirsutism on either CIMT and FMD values, among young patients was not significant. Since endothelial dysfunction might became evident after a long period of physio-pathological process, our findings obtained from younger patients may not really show the impact of hirsutism on endothelial function in short term.

Sonographic markers of ovarian morphology, but not hirsutism indices, predict serum total testosterone in women with regular menstrual cycles.

OBJECTIVE: To determine whether sonographic markers of ovarian morphology or male pattern hair growth scores predict androgen levels in women with regular or irregular menstrual cycles. DESIGN: Cross-sectional observational study. SETTING: Clinical research unit. PATIENT(S): Seventy-six women of reproductive age (18-39 years) were evaluated for male-pattern hair growth (using a modified Ferriman-Gallwey scoring system), ovarian morphology (by transvaginal ultrasonography), and total serum testosterone (T) (by liquid chromatography tandem mass spectrometry). INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Regional and total modified Ferriman-Gallwey scores, number of follicles per follicle size category, follicle number per ovary, ovarian volume, ovarian area, stromal to ovarian area ratio, stromal echogenicity index, total testosterone (total T), and menstrual cycle length. RESULT(S): Neither regional nor total modified Ferriman-Gallwey scores correlated with total T concentrations in women with regular or irregular menstrual cycles, as judged by the Least Absolute Shrinkage and Selection Operator technique. By contrast, a sonographic marker (follicle number per ovary 6-9 mm) significantly predicted total T concentrations in women with regular menstrual cycles but not in women with irregular menstrual cycles. CONCLUSION(S): Sonographic markers of ovarian morphology, but not hirsutism scores, predicted total T levels. However, the predictive value of ovarian morphology for total T differed by menstrual cycle status. That sonographic markers did not predict androgen levels in a diverse cohort of women with cycle irregularity suggests the potential for distinct variations in ovarian morphology for androgenic and nonandrogenic types of cycle irregularity. Overall, our findings support that an assessment of ovarian morphology may be helpful in reflecting total T levels.

Body imaging and sexual behavior in lean women with polycystic ovary syndrome.

INTRODUCTION: In women with polycystic ovary syndrome (PCOS), changes in body appearance may influence the feminine identity of the patients with possible consequent depression and sexual dysfunction. AIM: The study aims to examine the differences in mood, perceived body image, sexual behavior, and clitoral vascularization between lean PCOS patients and healthy eumenorrheic controls. METHODS: Thirty-three lean PCOS women (Group I) and 22 healthy nonhirsute volunteers (Group II) were submitted, on day 3-5 of the cycle, to ultrasonographic (US) and Doppler analyses, to clinical, hormonal, and biochemical evaluations, and to psychometric tests. MAIN OUTCOMES MEASURES: Main outcome measures are Ferriman-Gallwey score (FG), clitoral volume, clitoral artery Pulsatility Index, the two-factor Italian McCoy female questionnaire (MFSQ), the Stunkard Figure Rating Scale (FRS), and the Beck Depression Inventory (BDI) questionnaire. RESULTS: The FG score and the androgens resulted, as expected, more elevated in PCOS patients than in controls. However, the US assessment of the clitoral body volume and the resistances registered at the level of the dorsal clitoral artery did not show any difference between Group I and Group II patients. Moreover, the two-factor Italian MFSQ, the FRS, and the BDI were similar in both groups. CONCLUSIONS: It seems that in lean PCOS women, the moderate hirsutism and hyperandrogenism do not have any important influence on body image and self-esteem and, as a consequence, on sexual function.

Parallel variations of insulin-like peptide 3 (INSL3) and antimüllerian hormone (AMH) in women with the polycystic ovary syndrome according to menstrual cycle pattern.

CONTEXT: Antimüllerian hormone (AMH) and insulin-like factor 3 (INSL3) represent ovarian functional markers of granulosa and theca cells, respectively. OBJECTIVE: We conducted a prospective study to investigate AMH and INSL3 plasma levels in 3 groups of women with polycystic ovary syndrome (PCOS) classified according to menstrual cyclicity pattern and their relationship with ovarian morphology and hormonal levels. DESIGN AND PARTICIPANTS: AMH and INSL3 were measured in a cohort of 57 patients with PCOS, divided into 3 groups according to menstrual status: eumenorrheic (PCOS-E, n = 15), oligomenorrheic (PCOS-O, n = 25), and amenorrheic (PCOS-A, n = 17). Clinical and endocrine characteristics and ovarian morphology were compared among the groups. Twenty-seven age- and weight-matched women without hyperandrogenism were included as controls. RESULTS: According to the menstrual pattern, the women with PCOS-A and PCOS-O had higher INSL3 levels with respect to the control women (P = .025 and P = .004, respectively) and higher but not significant INSL3 levels compared with those of the women with PCOS-E. AMH levels were significantly higher in women with PCOS-A and PCOS-O with respect to those in women with PCOS-E (P < .001 and P < .001, respectively) and control women (P < .001 and P < .001, respectively). Interestingly, a significant positive correlation was found between INSL3 and AMH blood levels in all women with PCOS (R = 0.43; P = .002) and across the groups (R = 0.41; P < .001). CONCLUSIONS: INSL3 and AMH levels are significantly correlated with each other in women with PCOS, and they are significantly increased, particularly in the presence of amenorrhea and oligomenorrhea. INSL3 and AMH may reflect a dysfunction of PCOS thecal and granulosa cells, which are responsible for the increased androgen production and chronic anovulation of this condition.

Use of F 18-fluoro-D-glucose-positron emission tomography-computed tomography to localize a hilar cell tumor of the ovary.

OBJECTIVE: To describe provocative testing and alternative imaging strategies used to localize an androgen-producing tumor in a 58-year-old woman with severe hirsutism. DESIGN: Case report. SETTING: Clinical Research Center. PATIENT(S): A 58-year-old woman who was seen for evaluation of severe hirsutism. INTERVENTION(S): Serum androgen levels were measured at baseline, 4 hours after administration of 2000 IU of hCG, and 11 days after administration of 3.75 mg of leuprolide acetate (LA). Magnetic resonance imaging and F 18-fluoro-D-glucose-positron emission tomography-computed tomography (FDG-PET/CT) were performed. MAIN OUTCOME MEASURE(S): Description of preoperative provocative testing and imaging. RESULT(S): In response to hCG, T rose from 243 to 288 ng/dL then decreased to 233 ng/dL after LA administration. The FDG-PET/CT scan demonstrated focal hypermetabolism in the right pelvis, corresponding to a soft-tissue density on the noncontrast CT scan. Magnetic resonance images were correlated with the PET/CT, and the right ovary was identified. Right salpingo-oophorectomy was performed, and final pathologic examination revealed a hilar cell tumor with ovarian cortical hyperplasia. CONCLUSION(S): This case demonstrates the utility of provocative testing in the evaluation of a patient with severe hirsutism and illustrates the value of FDG-PET/CT when traditional imaging is nondiagnostic.

PCOS, sexuality, and clitoral vascularisation: a pilot study.

INTRODUCTION: In polycystic ovarian syndrome (PCOS) women, the changes in body appearance (mainly obesity and hirsutism) may influence the feminine identity of the patients with consequent depression and sexual disturbances. AIM: To evaluate if lean PCOS patients present an increased incidence of depression and sexual dysfunction in comparison with controls and if clitoral volume and vascularization are influenced by circulating androgens levels. METHODS: 25 lean PCOS women (Group I) and 18 healthy nonhirsute volunteers (Group II) were submitted, on day 3-5 of the cycle, to ultrasonographic and Doppler analyses, and to hormonal and biochemical evaluations. MAIN OUTCOME MEASURES: Utero-ovarian and clitoral ultrasonographic analysis, and color Doppler evaluation of the uterine, stromal ovarian, and dorsal clitoral arteries. Hormonal and nitrites/nitrates plasma concentrations were analyzed. Each woman filled in the 2-factor Italian McCoy female questionnaire (MFSQ) and the Beck's Depression Inventory questionnaire (BDI). RESULTS: Androgens resulted, as expected, more elevated in PCOS patients than in controls. However, the ultrasonographic (US) assessment of the clitoral body volume evidenced no significant differences between PCOS (0.72+/-0.41 mL) and control (0.62+/-0.20 mL) patients. The resistances registered at the level of the dorsal clitoral artery did not show any difference between Group I (PI=1.55+/-0.40) and Group II (PI=1.79+/-0.38). The 2-factor Italian MFSQ and the BDI did not show any difference between PCOS women and controls. CONCLUSIONS: In PCOS women, probably, the moderate hirsutism and hyperandrogenism do not induce the sense of loss of feminine identity and have no impact on sexual self-worth and sexual satisfaction.

The combination of increased ovarian volume and follicle number is associated with more severe hyperandrogenism in German women with polycystic ovary syndrome.

The prevalence and relevance of polycystic ovaries (PCO) in German women with polycystic ovary syndrome has not been evaluated. This retrospective study included 212 PCOS patients (mean age 28 years) diagnosed by the NIH-criteria and consecutively recruited since 2003. Clinical features including anthropometric variables and the degree of hirsutism, family history, menstrual cyclicity as well as endocrine biochemical parameters were recorded. In addition, 3-h oral glucose tolerance testing for indices of insulin resistance and glucose metabolism was performed in each patient. Transvaginal ultrasound was used to detect polcystic ovaries, defined as the presence of at least one ovary > 10 ml or with at least 12 follicles of 2-9 mm diameter. In this German PCOS cohort, PCO were identified in 166 women (78%). Women with PCO (PXO+) had significantly higher LH/FSH ratios (median 2.1 vs. 1.7) and IGF-1 levels (median 182.5 vs. 160.5 ng/ml) compared to patients without PCO (PCO-). In addition, a significantly higher prevalence of acne (50% vs. 33%) and higher hirsutism scores (median 9 vs. 7) were found in PCO+ patients. Testosterone levels and the free androgen index (FAI) correlated significantly with ovarian volume and the number of ovarian follicles. Also, a subgroup of PCO+ women with a combination of increased ovarian volume and follicle number had higher testosterone levels (median 3.1 vs. 2.1 nmol/l) and FAI (median 7.6 vs. 4.5) compared to women with increased follicle count but normal volume. No differences were found in metabolic parameters or insulin resistance indices. PCO are common finding in German PCOS women. PCO appear to be associated with a more pronounced hyperandrogenemia, especially when both ovarian volume and follicle number are increased.

Polycystic ovaries in Hirsute women with normal menses.

PURPOSE: Hirsute women with normal ovulatory menstrual function are often diagnosed as having idiopathic hirsutism. We prospectively evaluated 62 hirsute ovulatory women to determine if they had a subtle form of polycystic ovary syndrome, and if they exhibited any of the metabolic abnormalities commonly associated with classic polycystic ovary syndrome. METHODS: Baseline hormonal profiles, ovarian responses to gonadotropin-releasing hormone agonist, and ovarian morphology by ultrasound were compared in the hirsute women and two groups of ovulatory controls. RESULTS: Among 62 women, only 8 (13%) had normal androgen levels and were considered to have idiopathic hirsutism. Twenty-four (39%) had characteristic polycystic ovaries on ultrasound, an exaggerated response of 17-hydroxyprogesterone to leuprolide, or both, suggesting ovarian hyperandrogenism and the diagnosis of mild polycystic ovary syndrome. The remaining 30 women (48%) were considered to have unspecified hyperandrogenism. Age, body weight, and androgen level were similar among the hyperandrogenic subgroups. However, when compared with both normal and overweight controls and with patients with idiopathic hirsutism, the women who had mild polycystic ovary syndrome had higher fasting insulin levels [P < 0.01, mean (+/- SD) increase of 7 +/- 3 microU/mL], lower glucose-insulin ratios (P < 0.01, mean reduction of 3 +/- 1.5), higher low-density lipoprotein cholesterol levels (P < 0.05, mean increase of 26 +/- 10 mg/dL), and lower high-density lipoprotein (HDL) cholesterol levels (P < 0.01, mean reduction of 10 +/- 4 mg/dL). Compared with patients who had unspecified hyperandrogenism, these women also had higher fasting insulin levels (P < 0.05), lower glucose-insulin ratios (P < 0.05), and lower HDL cholesterol levels (P < 0.05). CONCLUSION: These data suggest that mild polycystic ovary syndrome is more common than idiopathic hirsutism, and it is also associated with subtle metabolic abnormalities.

Idiopathic hirsutism or polycystic ovary syndrome?

Polycystic ovaries (PCO) were detected using ultrasound imaging in a series of 173 women who presented with significant hirsutism and in some cases with irregular menstruation. Patients were divided into 3 groups. Those with hirsutism and regular menstruation (cycles > 8 per year, Group 1, n = 96); those with hirsutism and oligomenorrhoea (cycles < 8 per year, Group 2, n = 44) and those with hirsutism and amenorrhoea (cycles < 2 per year, group 3, n = 33). These 3 groups were compared with subjects with normal ovaries and regular cycles of 26-34 days and without hirsutism (n = 29) and also with a group of women with PCO and regular cycles who had no sign of hirsutism (n = 90). PCO were found in 86% of Group 1, 97% of Group 2 and 94% of women within Group 3. The results suggest that the term 'idiopathic hirsutism' may not be appropriate. An abnormal biochemical test consisting of a luteinizing hormone level > 9 U/L, testosterone level > 2.2 nmol/L, sex hormone binding globulin < 32 nmol/L or free androgen index > 4.5 was 100%, 91% and 76% sensitive for detecting PCO amongst women with amenorrhoea, oligomenorrhoea and idiopathic hirsutism respectively.

[Endocrine and ultrasound examination of hirsutism]. / Endokrinologische und ultrasonografische Untersuchung des Hirsutismus.

One hundred and fourteen nontumorous hirsute women were investigated. The degree of hirsutism, the menstrual abnormalities and the level of 17-ketosteroids, of DHEA, of 17-OH-corticoids in urine and RIA of total and free testosterone and of sex binding globulins (SHBG) in blood were performed. On the basis of endocrinological and ultrasonographic determinations 3 patients were diagnosed as congenital adrenal hyperplasia, 35 patients as late onset adrenal hyperplasia and 57 women as polycystic ovary syndrome (PCO). The maximal mean level (X + SD) of total and free testosterone above 0.5 ng/ml relatively above 5.05 pg/ml were performed in 94.3% relatively 97.1% in late onset adrenal hyperplasia and in 78.9% relatively 87.7% in PCO. The diagnosis of PCO is possible among 75% of all hirsute patients after exclusion the patients with late onset adrenal hyperplasia. The PCO is confirmed by hormonal or/and ultrasonographic examination. The diagnosis of late onset adrenal hyperplasia is allowable only by hormonal investigation.

The relationship of I-131 6 beta-iodomethyl-19-norcholesterol (NP-59) adrenal cortical uptake to indices of androgen secretion in women with hyperandrogenism.

Dexamethasone suppression (DS) adrenal cortical scintigraphy has been shown to be useful in the detection of the adrenal pathology in women with hyperandrogenism. However, a relationship between adrenal cortical uptake of I-131 6 beta-iodomethylnorcholesterol (NP-59) and the level of adrenal androgen secretion has not been established. A retrospective analysis of DS adrenal scintiscans has been performed on 39 women with hirsutism and hyperandrogenism. In 14 patients with normal patterns of imaging, in vivo adrenal gland iodocholesterol uptake, calculated using a semi-operator-independent-computer algorithm, did not correlate with the excretion of urinary 17-ketosteroids (17-KS). In contrast, in 20 patients demonstrating abnormal bilateral early imaging patterns, adrenal gland NP-59 uptake correlated significantly with the level of urinary 17-KS excretion (r = 0.65, P less than 0.05). To date seven of these 20 patients have had confirmatory procedures documenting the adrenal glands as contributing sites of androgen secretion. A similar correlation with urinary 17-KS excretion was seen in five other patients with unilateral imaging patterns (r = 0.94, P less than 0.005), due to androgen-secreting adrenal cortical adenomas. No correlation between adrenal NP-59 uptake and plasma testosterone or dehydroepiandrosterone sulphate levels was observed in any of the groups. Thus, adrenal gland uptake of NP-59 under DS reflects a measure of androgen secretion in women with androgen excess.

[Diagnosis in progressive hirsutism. Catheter technique and results (author's transl)]. / Diagnostik bei progredientem Hirsutismus. Kathetertechnik und Ergebnisse.

Catheterization of adrenal and ovarian veins in combination with hormone concentration analyses was performed in seventy hirsute women. There was suspicion of tumor in 30 cases because of excess androgen production (plasma testosterone more than 1,5 ng/ml and/or plasma dehydroepiandrosterone sulfate more than 7000 ng/ml in peripheral blood samplings). Catheterization and blood sampling was done with a femoro-visceral catheter by the transfemoral approach. Contributary blood flows from many different venous systems were found to be more often to the right ovarian and to the left adrenal veins in comparisons to the other side. Catheterization of the wrong vessels occurred without being recognized immediately (circumaortic renal collar, inferior phrenic vein, ascending lumbar vein). These pitfalls might falsify blood samplings. There were no significant complications. Seven ovarian tumors were localized. Their size ranged from 0,5 to 2,5 cm in diameter. They were not recognized during laparoscopy. There were 10 hyperthecoses, four adrenogenital syndromes, one abortive testis, one adrenal adenoma, one Cushing's syndrome and one Cushing's disease due to an adenoma of the pituitary gland. In five patients a diagnosis could not be made. Tumor was excluded in forty patients. Their virilization was of adrenal origin in 32%, of ovarian origin in 29%, and of both adrenal and ovarian origin in 22%. In 17% a source of the excess androgen production was not found. This differential diagnosis is not important for the patient therapy.

Dexamethasone-suppression adrenal scintigraphy in hyperandrogenism: concise communication.

To assess the contribution of adrenal-derived androgens in women with hirsutism, adrenal scintigrams under dexamethasone suppression (DS) were performed on 35 women with increasing facial or body hair and irregular or absent menses. Based upon the DS regimen chosen (8 mg/d for 2 days or 4 mg/d for 7 days before the injection of 6 beta-[131I]iodomethylnorcholesterol), three imaging patterns were identified. The first was the absence of uptake before 3 days (8-mg DS) or before 5 days (4-mg DS) after injection. This imaging pattern was seen in 17 of the 35 patients studied and was considered normal. The second pattern was bilateral uptake earlier than 3 days (8-mg DS regimen) or 5 days (4-mg DS) after injection. This was seen in 13 of the 35 patients and was interpreted as bilateral early visualization. Adrenal-vein catheterization performed on six patients with this pattern showed increased adrenal-vein testosterone. The third pattern, observed in five patients, was unilateral early visualization, which in four cases investigated to date was the result of an adrenocortical adenoma. This study confirms the adrenal cortex as a source of androgens in women with hirsutism and hyperandrogenism and demonstrates the DS adrenal scintigraphy can be utilized to identify those women in whom adrenal-derived androgens contribute to their hyperandrogenism.

The role of computed tomography in assessment of tumoral pathology of the adrenal glands.

The findings at computed tomography (CT) of the adrenal glands in 58 patients are presented. Most patients (50) were referred for suspected adrenal dysfunction. In three, adrenal masses were suspected from other radiological studies. Three patients had palpable abdominal masses, and incidental adrenal metastases were found in two. Pathological findings included pheochromocytomas (nine patients), adrenocortical adenomas (six), adrenocortical carcinomas (three), metastases (two), and one example each of myelolipoma, hemorrhagic renal cyst, and probable granuloma. Of 24 adrenal masses, 23 were clearly apparent in the scans and one was suspected. The smallest tumor diagnosed was 0.5 cm in diameter. There was on false positive diagnosis of a small tumor and no known false negatives. Because of their consistent location and unusual shape and because they are usually surrounded by retroperitoneal fat, the adrenal glands are ideal organs for study by CT, a highly accurate method for detecting and excluding mass lesions that may render arteriography and venography unnecessary. Surgery was performed in five patients with tumors following localization by CT only. Limitations and potential diagnostic pitfalls in interpretation are discussed.