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Radiology
Fetal Adrenal Abnormalities
Built from Obstetric Imaging
What’s inside
6 sections · 110 slides
Overview
- What this topic is about
- Three ways the fetal adrenal gland goes wrong
- Why these findings matter
The normal fetal adrenal gland
Where it sits, how it looks, and how it changes
- Where the adrenal glands sit
- Normal fetal adrenal gland on ultrasound
- What the gland looks like on the scan
- How the gland changes across pregnancy
- Sorting an adrenal finding into three groups
- Fetal Adrenal Masses
Neuroblastoma
The commonest solid mass in the fetal adrenal gland
- What a neuroblastoma is
- Where in the body neuroblastomas start
- The ones found before birth are nearly all adrenal
- 58 / million
- Who gets it, and when
- The outlook is better than the word 'malignant' suggests
- Why finding it before birth helps
- How a neuroblastoma comes about
- The window between 15 and 20 weeks
- What might raise the risk: maternal medicines
- What lowers the risk: folate and vitamins
- Other perinatal associations
- Genes linked to neuroblastoma
- Conditions that carry a higher risk
- Familial cases and tumour chromosomes
- What the tumour does inside the uterus
- When the tumour releases catecholamines
- How the newborn presents
- Where neuroblastoma spreads
- The urine tests that confirm it
- What the mass looks like on ultrasound
- Which side, and why that matters
- Using Doppler to exclude a lung rest
- Adrenal mass suspicious for neuroblastoma
- What magnetic resonance imaging adds
- The classic picture
- What else it could be
- Managing the pregnancy
- Planning the delivery
- Treatment after birth
- What the referring physician needs to know
Adrenal haemorrhage
A bleed that changes its face week by week
- What adrenal haemorrhage is
- The fetal adrenal gland is surprisingly large
- How blood gets in and out
- How common it is
- Why the right gland bleeds more
- What sets off the bleed
- What happens to the blood afterwards
- How it presents
- Why adrenal failure is rare after a bleed
- How the bleed changes on scan over time
- Reading the stages one by one
- Organising clot in the left adrenal gland
- Resolved hematoma leaving an adrenal cyst
- The same cyst collapsing on a later scan
- What the three scans of one fetus teach
- Calcification after a resolved adrenal bleed
- Adrenal hematoma at 37 and 39 weeks
- The 39-week collection enlarged
- The one test that separates bleed from tumour
- Where magnetic resonance imaging fits
- What else it could be
- Managing the pregnancy
- Care after birth
- What the referring physician needs to know
Congenital adrenal hyperplasia
When the gland is built right but works wrong
- What congenital adrenal hyperplasia is
- Why the gland enlarges
- Which enzyme is usually at fault
- How common the faulty gene is
- 1:42,000
- The adrenal steroid synthesis pathways
- The step that 21-hydroxylase deficiency blocks
- Reading the pathway diagram
- The rarer enzyme faults
- How one blocked step causes the whole syndrome
- Following the loop in plain words
- The genetics
- Two forms of 21-hydroxylase deficiency
- The classic form in the newborn
- The salt-wasting emergency
- The late-onset form
- Ambiguous genitalia on a fetal scan
- What ultrasound can and cannot show
- What else it could be
- How the diagnosis is made after birth
- How the diagnosis is made before birth
- The idea behind prenatal dexamethasone
- The awkward timing problem
- What prenatal treatment does not do
- Why the treatment became controversial
- Where the guidelines stand
- Treatment after birth
- Surgery for ambiguous genitalia
- What the referring physician needs to know
Pulling it together
Telling the three apart, and what to remember
- Adrenal anomalies beside the masses that mimic them
- Reading the imaging comparison table
- Typical Ultrasound and Magnetic Resonance Imaging Characteristics of Suprarenal Masses
- Neuroblastoma or haemorrhage?
- Three conditions in one line each
- Key points
- Key points continued
- Suggested reading
- References
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- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition