Adrenal calcification describes the deposit of calcium salts within the tissue of the adrenal glands. These small, triangular glands are situated on top of each kidney and are responsible for producing several hormones that regulate the body’s stress response, blood pressure, and metabolism. When calcium builds up in these glands, it can cause the tissue to harden.
Adrenal calcification is not a disease itself. Rather, it is a finding that appears on medical imaging tests, such as a CT scan or X-ray. The presence of these calcium deposits points toward a past or present process affecting the glands, and the significance of this finding depends on the underlying reason for the calcification, which can range from harmless to indicative of a more serious condition.
Underlying Causes of Adrenal Calcification
The development of adrenal calcification is most frequently linked to a previous bleeding event, known as an adrenal hemorrhage. This is particularly common in newborns who experience stress during birth, leading to a neonatal adrenal hemorrhage. As the body heals and resorbs the blood from the hemorrhage, calcium deposits can form in the remaining scar tissue. In adults, hemorrhages can be caused by physical trauma or severe physiological stress like widespread infection (sepsis).
Infections are another cause of calcification in the adrenal glands. Historically, tuberculosis was a primary infectious cause, leading to tissue death prone to calcification. Other infections, such as those caused by fungi like histoplasmosis, can also result in adrenal calcification. While less common today due to effective treatments, these infectious roots are still considered during diagnosis.
The presence of a tumor can also lead to calcium deposits within the adrenal gland. These tumors can be either benign, meaning non-cancerous, or malignant. Benign growths like adrenal adenomas rarely calcify, but it can happen. In children, neuroblastoma can present with calcifications, and in adults, adrenocortical carcinoma, a rare cancer, may also contain areas of calcification.
In some instances, the cause of adrenal calcification is less common or remains unknown, termed idiopathic. Adrenal cysts, which are fluid-filled sacs, can sometimes develop calcified walls. Certain rare genetic disorders, such as Wolman disease, a condition affecting fat metabolism, can also lead to enlarged and calcified adrenal glands in infants. A significant percentage of incidental adrenal calcifications are classified as idiopathic when a definitive cause cannot be identified.
Symptoms and Diagnosis
In most cases, adrenal calcification itself produces no symptoms. Its discovery is often accidental, appearing as an “incidental finding” on an imaging study ordered for an unrelated medical issue. A radiologist might note the calcified spots on a CT scan or X-ray ordered for an unrelated issue.
The primary diagnostic tools for identifying adrenal calcification are imaging technologies. CT scans are effective at revealing these dense calcium deposits. Ultrasounds and magnetic resonance imaging (MRI) can also detect adrenal abnormalities, including calcification, and help assess the gland’s structure. The specific pattern of the calcification can sometimes offer clues to the underlying cause.
When symptoms are present, they are not caused by the calcium itself but by the underlying condition. For example, if a large tumor is the cause, a person might experience symptoms related to the overproduction of adrenal hormones, such as high blood pressure or weight gain. If an infection or extensive hemorrhage has damaged both adrenal glands, it could lead to adrenal insufficiency, with symptoms like fatigue, muscle weakness, and low blood pressure.
Treatment Approaches
The management strategy for adrenal calcification is directed at the underlying cause, not the calcium deposits themselves. The calcifications are considered a permanent marker of a past injury and are not removed or treated directly. Their presence prompts a medical investigation to determine the cause, which dictates the subsequent course of action.
For many individuals, when the calcification is determined to be from an old hemorrhage or is idiopathic with no associated hormonal issues, the recommended approach is observation. This “watchful waiting” may involve periodic follow-up imaging studies, such as a CT scan every year or two, to ensure that the calcified area remains stable and that no new changes develop. This is a common outcome for incidental findings.
Active treatment is reserved for situations where the calcification is associated with an active medical condition. If a bacterial or fungal infection is identified as the cause, a course of antibiotics or antifungal medication will be prescribed. In cases where damage to both glands has resulted in adrenal insufficiency, hormone replacement therapy is necessary to supplement the hormones the body no longer produces.
If a tumor is identified as the source of the calcification, the treatment plan will depend on whether the tumor is benign or malignant. Benign tumors may be monitored or surgically removed if they are large or producing excess hormones. Malignant tumors, such as adrenocortical carcinoma or a metastasis from another cancer, require surgical excision and may be followed by other cancer therapies.