“Identifying enhancing soft tissue can be challenging inthe acute setting. Furthermore, rapid or marked enlargementof an adrenal mass due to hemorrhage can be difficultto distinguish from growth of a malignant mass. There areno established guidelines for follow-up to assess for an underlying mass after resolution of hemorrhage; however,follow-up imaging is often warranted, and 6–12 weeks afterresolution of the hemorrhage is reasonable. Of note, mildelevation of plasma normetanephrine levels can occur secondary to hemorrhage and irritation of medullary cells.”
Adrenal Neoplasms: Lessons from AdrenalMultidisciplinary Tumor Boards
Ryan Chung et al.
RadioGraphics 2023; 43(7):e220191 July 2023

“There areno established guidelines for follow-up to assess for an underlying mass after resolution of hemorrhage; however,follow-up imaging is often warranted, and 6–12 weeks after resolution of the hemorrhage is reasonable.”
Adrenal Neoplasms: Lessons from AdrenalMultidisciplinary Tumor Boards
Ryan Chung et al.
RadioGraphics 2023; 43(7):e220191 July 2023

“Hemorrhage is a rare complication; however, pheochromocytoma is the most common primary tumor to hemorrhage. Although the underlying mechanism of pheochromocytoma with hemorrhage is unknown, some theories suggest increased intracapsular pressure from trauma, a rapidly enlarging tumor that outgrows its blood supply, and vasodilatation and interstitial hemorrhage caused by the use of antihypertensive medications. Patients may present withsymptoms of a hypertensive crisis secondary to excessivecatecholamine release from a ruptured pheochromocytoma.”
Adrenal Neoplasms: Lessons from AdrenalMultidisciplinary Tumor Boards
Ryan Chung et al.
RadioGraphics 2023; 43(7):e220191 July 2023

“The most common clinical presentation for functioning ACC is Cushing’s syndrome, characterized by symptoms related to excess corticosteroid synthesis including truncal obesity, diabetes, hypertension, easy bruising, and menstrual cycle irregularities. In females, virilization resulting from excess androgens may accompany signs of excess cortisol. A small percentage of male patients, present with signs of estrogen excess, such as gynecomastia, breast tenderness, decreased libido, and testicular atrophy.”
Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management 
Ayahallah A. Ahmed et al.
Abdom Radiol (NY) 2020 Apr;45(4):945-963

“ACCs are typically large, with roughly 70% of tumors larger than 6 cm at the time of diagnosis. Size of the adrenal tumor, pattern of contrast enhancement, and degree of heterogeneity by CT are all important predictors of the malignant potential of the adrenal lesion. ACC is typically heterogeneous by CT and displays mixed intratumoral attenuation. An attenuation value of more than 10 HU on non-contrast CT has high sensitivity for detecting malignancy (93%), but a specificity of only 71–73%. Contrast enhancement is heterogeneous and may be increased peripherally due to central necrosis.”
Adrenal cortical carcinoma: pathology, genomics, prognosis, imaging features, and mimics with impact on management 
Ayahallah A. Ahmed et al.
Abdom Radiol (NY) 2020 Apr;45(4):945-963