Adrenal nodules in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency: Regression after adequate hormonal control

Adrenal nodules have been described in patients with 21-hydroxylase deficie ncy (21OHD), These nodules are usually considered to be ACTH-dependent, as is the commonly seen diffuse cortical hyperplasia, We evaluated the presenc e and behavior of adrenal nodules in patients with 21OHD, Based upon hormon al status and treatment compliance, the patients were classified into three categories: poor, regular and good control, Out of the 26 patients, eight had the non-classic, four salt-wasting and 14 simple virilizing forms. All patients underwent initial adrenal morphological studies, either by CT or M RT, Those with nodules were reevaluated after 12 months of adequate replace ment therapy. Nodules were found in four of eight untreated patients and tw o of three patients with poor hormonal control, but not in the 15 patients with regular or good control, Adrenal nodules in these six patients demonst rated a considerable size reduction and even disappearance after adequate r eplacement therapy, showing that these nodules were ACTH-dependent, Thus, s ix out of 26 patients with 21OHD presented adrenal nodules, which were more frequent in the untreated or poorly-controlled patients, and all regressed in size after adequate therapy.