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Congenital Adrenal Hyperplasia || Ultrasound || Pediatrics || Case 288
Clinical Features:
A 6 hours old neonate was sent for assessing genitalia, adrenal glands and ovaries/testes.
Ultrasound Features:
- Bilateral diffusely enlarged & wrinkled adrenal glands with maintained hypoechoic cortex & hyperechoic medulla similar to cerebral gyri and sulci forming ‘cerebriform pattern’.
- Enlarged clitoris.
- Partly fused labia majora with rugae.
- No testicular structures.
Remember:
- Single limb of adrenal gland ≥ 4 mm is considered enlarged.
- Cerebriform appearance is caused by hypertrophied adrenal gland folding back upon itself.
- Left adrenal gland is usually larger than right.
- Potential space for right adrenal gland is smaller due to liver.
- Normal adrenal glands do not exclude CAH.
Ref:
- Atlas of Ultrasound Measurements, 2nd Ed, Goldberg, McGahan
- Diagnostic Imaging: Pediatrics, 4th ed, Merrow, Aquino, Linscott, Koch
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