, Volume 59, Issue 3, pp 529–537 | Cite as

The computed tomography adrenal wash-out analysis properly classifies cortisol secreting adrenocortical adenomas

  • Anne-Laure Humbert
  • Guillaume Lecoanet
  • Sophie Moog
  • Fehd Bouderraoui
  • Laurent Bresler
  • Jean-Michel Vignaud
  • Elodie Chevalier
  • Laurent Brunaud
  • Marc Klein
  • Thomas CunyEmail author
Original Article



Adrenocortical lesions are characterized through imaging, hormonal and histopathological analysis. Our aim was to compare the radiological features of adrenocortical lesions with their cortisol-secreting status and histopathological Weiss score.


Seventy five patients operated between 2004 and 2016 in the University Hospital of Nancy for either adrenocortical carcinomas (ACC) or adrenocortical adenomas (ACA) were enrolled in this study. We collected cortisol parameters, Computed Tomography (CT) scans (unenhanced density, wash-out (WO) analysis) and 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) datas. The histopathological Weiss score ultimately differentiates ACA (score ≤ 2) from ACC (score ≥ 3). One-way ANOVA, Fisher’s exact and unpaired t tests were used for statistical analysis with significancy reached at p < 0.05.


There were 23 ACC and 52 ACA with 40 patients (53%) who had an autonomous secretion of cortisol. On CT scan, ACC were larger compared to ACA (108 vs. 37 mm, p < 0.0001). A roughly similar proportion of cortisol-secreting (22/25) and non-secreting (15/19) ACA were atypical (i.e., unenhanced density value ≥ 10 Hounsfield Units [HU]), however 85% of cortisol-secreting vs. 40% of non-secreting ACA were classified as benigns by the relative WO analysis (p = 0.08). Likewise, there was a trend for a higher 18F-FDG uptake in cortisol-secreting ACA compared to non-secreting ACA (p = 0.053).


The relative adrenal WO analysis consolidates the benign nature of an ACA, especially in case of cortisol oversecretion, a condition known to compromise the diagnostic accuracy of the 10 HU unenhanced CT attenuation threshold.


Incidentaloma Adrenal adenoma Cushing’s syndrome 18F-FDG/PET Weiss score 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

12020_2018_1522_MOESM1_ESM.docx (156 kb)
Supplementary Table


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Anne-Laure Humbert
    • 1
  • Guillaume Lecoanet
    • 2
  • Sophie Moog
    • 1
  • Fehd Bouderraoui
    • 3
  • Laurent Bresler
    • 4
  • Jean-Michel Vignaud
    • 5
  • Elodie Chevalier
    • 3
  • Laurent Brunaud
    • 4
  • Marc Klein
    • 1
  • Thomas Cuny
    • 1
    Email author
  1. 1.Department of EndocrinologyUniversity Hospital of NancyNancyFrance
  2. 2.Department of RadiologyUniversity Hospital of NancyNancyFrance
  3. 3.Department of Nuclear MedicineUniversity Hospital of NancyNancyFrance
  4. 4.Department of Endocrine and General SurgeryUniversity Hospital of NancyNancyFrance
  5. 5.Department of AnatomopathologyUniversity Hospital of NancyNancyFrance

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