Fact-sheet: Adrenocortical hyperplasia


Updated on 09/25/2025 at 2:39 PM

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Definition

Adrenal hyperplasia is defined as non-tumoral enlargement of the adrenal glands.

It can be:

  • congenital congenital adrenal hyperplasia
  • primary pigmented nodular adrenocortical disease
  • acquired bilateral adrenal hyperplasia is one of the causes of primary hyperaldosteronism.

In a context of primary hyperaldosteronism, bilateral adrenal hyperplasia can be diagnosed when the mean thickness of the adrenal limbs is > 5mm.

Clinical features

Clinical signs related to primary hyperaldosteronism:

  • Resistant hypertension, early-onset (<50 years) and/or stroke
  • Asthenia

Clinical signs related to congenital adrenal hyperplasia:

  • Virilization, precocious puberty, hirsutism
  • Testicular tumor
  • Hypotension

Laboratory findings

Diagnosis of primary hyperaldosteronism:

  • Hypokalemia (9-37% of cases)
  • Hyperaldosteronemia: >18 ng/dl or >0.5 nmol/l
  • Elevated aldosterone/renin ratio: >34 ng/dl or >0.95 nmol/l
  • Confirmation by fludrocortisone suppression test or saline infusion test

Genetic testing in cases of congenital adrenal hyperplasia.

Ultrasound

Role in pediatric congenital adrenal hyperplasia:

  • Cerebriform enlargement of the Adrenal glands
  • Search for associated testicular mass

CT

Size criteria:

  • Increased mean thickness of the adrenal limbs > 5 mm
  • Increased thickness of the adrenal bodies > 10 mm

Morphological criteria:

  • Convex margins
  • if lobulated margins: micronodular hyperplasia
  • if nodules: macronodular hyperplasia

Differential diagnosis

Adrenocortical adenoma