When people have adrenal insufficiency they must be sure to pay special attention to times of increased stress on the body such as those undergoing surgery, those suffering from an illness or severe injury, and those who are pregnant. Even taking part in strenuous sports or exercise or working night shifts can affect cortisol levels. Some of these types of stress would require additional treatment to recover including “stress” dosages of corticosteroids, which may be given either intravenously or orally. When the person recovers from the stress situation, they can usually return to their usual amounts of medications.
If your doctor suspects secondary adrenocortical insufficiency, you may get infusions of ACTH on 2 days in a row. In most cases, your adrenal glands will make cortisol by the end of the second treatment. This is true even if you have problems with the pituitary gland or hypothalamus. If possible, your doctor will treat the condition that is causing secondary adrenocortical insufficiency. Your doctor may start treatment during the testing if he or she thinks adrenal insufficiency is likely. If it turns out that you don't need treatment, you can stop treatment after testing is complete.
The imaging diagnosis of myelolipomas is based on the presence of macroscopic fat. MRI characteristics include T1-hyperintense signal that suppresses with frequency-selective fat saturation (Figure 3). 33 Similar to renal angiomyolipomas, the presence of the India Ink (chemical shift) artifact at the myelolipoma-adrenal interface or within an adrenal mass on OOP images should indicate a myelolipoma. 34 Small quantities of macroscopic fat are not completely specific for myelolipoma. In addition to adenomas, a recent retrospective study of 41 adrenocortical carcinomas suggested that 10% contained foci of macroscopic fat. 35 In contrast to renal angiomyolipomas, small amounts of macroscopic fat should be considered characteristic, but not diagnostic, of myelolipomas. 33 Other imaging features (margins, invasion, heterogeneity etc.) should be considered to exclude a rare, fat-containing malignancy. Otal et al 36 reported that a lesion with composition of greater than 50% macroscopic fat can be managed as a myelolipoma.