Role of computed tomography in predicting adrenal adenomas with cortisol hypersecretion.

This article investigates the role of computed tomography (CT) in differentiating adrenal adenomas with cortisol hypersecretion from other adenoma subtypes in patients with surgically confirmed adrenal adenomas. Using multiphase adrenal CT parameters—including lesion size, attenuation on unenhanced CT (UCT), and contralateral adrenal atrophy assessed both quantitatively and qualitatively—multivariate prediction models were developed and internally validated. The models demonstrated good diagnostic performance, with areas under the curve (AUCs) exceeding 0.85 for overt cortisol hypersecretion and above 0.75 for mild hypersecretion, suggesting that CT findings, particularly lesion attenuation and adrenal atrophy score, may aid in subtyping adrenal adenomas beyond the conventional differentiation of adenomas from non-adenomas. The study highlights the potential clinical utility of CT in guiding biochemical testing and management of adrenal incidentalomas, while noting limitations such as the retrospective design, inclusion of only surgical cases, and the need for further prospective validation.