DISEASES OF THE ADRENAL GLANDS - CLINICAL FINDINGS
Pancreatic Disease	Symptoms	Signs	Abnormal Lab Test Results	Abnormal Imaging Findings	Initial Treatment	General and Follow-Up Treatment	Age Range(s) Typically Found	Prognosis
Cushing's Syndrome	Weight gain, moon face, buffalo hump, hypertension, muscle weakness	Central obesity, purple striae, hirsutism, easy bruising	↑Cortisol, ↑ACTH (if ACTH-dependent), failed dexamethasone suppression test	Adrenal hyperplasia or tumor on CT/MRI, pituitary tumor if Cushing’s disease	Surgical removal if tumor; ketoconazole, metyrapone if not surgical	Monitor cortisol levels post-treatment, manage osteoporosis and diabetes	Adults 20-50 years, more common in women	Good with treatment, high morbidity if untreated
Addison's Disease	Fatigue, weight loss, salt craving, nausea, hypotension	Hyperpigmentation, orthostatic hypotension, loss of body hair	↓Cortisol, ↑ACTH, hyponatremia, hyperkalemia, ↓Aldosterone	Small adrenal glands on CT/MRI, sometimes calcifications	Glucocorticoid and mineralocorticoid replacement (hydrocortisone, fludrocortisone)	Lifelong hormone replacement, monitor for crisis triggers	Any age, most common in middle-aged adults	Good with lifelong hormone replacement, fatal if untreated
Primary Aldosteronism	Hypertension, muscle cramps, polyuria, headache	Resistant hypertension, hypokalemia, metabolic alkalosis	↑Aldosterone, ↓Renin, hypokalemia, metabolic alkalosis	Unilateral adrenal adenoma or bilateral hyperplasia on imaging	Spironolactone or eplerenone; surgical removal if unilateral	Blood pressure and potassium monitoring, long-term medication if needed	Middle-aged to older adults, more common in women	Good if treated, increased cardiovascular risk if uncontrolled
Pheochromocytoma	Episodic headaches, palpitations, sweating, hypertension	Tachycardia, sweating, pallor, severe hypertension	↑Metanephrines, ↑Catecholamines in plasma and urine	Adrenal mass with high contrast washout on CT, MRI hyperintensity	Surgical removal of tumor; alpha-blockade (phenoxybenzamine) pre-op	Regular biochemical testing for recurrence, genetic screening for syndromes	Adults 30-60 years, rare in children	Good with complete removal, risk of recurrence if genetic
Adrenal Incidentaloma	Often asymptomatic, may have mild hormone excess symptoms	May show mild hypercortisolism, hyperaldosteronism, or be non-functional	Variable; possible mild ↑Cortisol, ↑Aldosterone, or catecholamines	Incidental adrenal mass, >4 cm may suggest malignancy	Observation for small, non-functional lesions; surgery if >4 cm or hormonal	Repeat imaging and hormonal testing if needed	Any age, more common in older adults	Generally good; malignancy risk increases with size
Congenital Adrenal Hyperplasia (CAH)	Ambiguous genitalia in newborns, precocious puberty, salt-wasting crisis	Hyperpigmentation, virilization in females, hypertension	↑17-OH progesterone, ↓Cortisol, ↓Aldosterone, ↑Androgens	Bilateral adrenal hyperplasia on imaging	Hydrocortisone, fludrocortisone for salt-wasting type	Lifelong glucocorticoid and mineralocorticoid replacement if necessary	Newborns and infants, detected via screening	Good with treatment; can cause serious complications if untreated
Adrenocortical Carcinoma	Abdominal pain, weight loss, hormonal symptoms depending on secretion	Abdominal mass, Cushingoid features, virilization or feminization	↑Cortisol, ↑DHEA, variable aldosterone and androgen levels	Large adrenal mass, irregular margins, invasion of surrounding structures	Surgical removal if localized; chemotherapy if metastatic	Oncologic follow-up, high recurrence risk if metastatic	Middle-aged to older adults, rare but aggressive	Poor prognosis if metastatic; localized cases may be curable
Adrenal Hemorrhage	Acute flank pain, hypotension, fever, shock in severe cases	Flank tenderness, signs of adrenal insufficiency if bilateral	↓Cortisol if severe, anemia, thrombocytopenia	Adrenal enlargement or hemorrhagic changes on CT/MRI	Supportive care, treat underlying cause, adrenalectomy if needed	Monitor adrenal function, replace hormones if necessary	Any age, commonly in critically ill patients	Variable; mild cases recover, severe cases can be fatal