The spectrum of adrenal lesions in the pediatric population
Type:Educational Electronic Presentation
Authors: Ana Sofia Alves, Rita Carneiro, Eugénia Soares
Keywords:Adrenal lesions; Adrenal imaging; Pediatric
Educational objective

To review the anatomy and basic embryology of the adrenal glands.

To describe and illustrate the main characteristic imaging features of pediatric adrenal lesions that can help the radiologist to establish the correct diagnosis.

Topic Review



The adrenals are paired endocrine glands located in the upper retroperitoneum, that lie superiorly and anteromedially to the kidneys.

The adrenal glands are made of an outer cortex and an inner medulla, that arise from separate embryologic structures:

  • the adrenal cortex is mesodermal in origin and arises from the urogenital ridge
  • the adrenal medulla is ectodermal in origin and arises from neural crest tissue


The normal adrenal gland size is age dependent. During the fetal and early postnatal period, the adrenal gland is formed by three layers (fig. 1):

  • the innermost → medulla
  • the intermediate → the fetal cortex... more

Figure 1. Schematic drawing illustrating the development of the adrenal glands (adapted from Developing Human Clinically Oriented Embryology).
Figure 2. Normal adrenal glands in a 3-day-old girl (circle). (a, b) Gray-scale US images of the right (a) and left (b) renal fossae show normal V-shaped adrenal glands with a central echogenic medulla and a peripheral hypoechoic cortex.


The diagnosis of adrenal lesions can be challenging, but imaging plays a key role in the detection and characterization of adrenal lesions and potential mimics of disease.

The patient’s age, clinical history and laboratory data can further help narrow the differential diagnosis and guide the treatment approach.