Adrenal Functional Disorders
Adrenal disorders come down to "is it functional, and if so, which hormone?" — each functional tumour has a screening test, a confirmatory step, and a treatment.
The big picture
Adrenal disorders come down to "is it functional, and if so, which hormone?" Each functional tumour has a screening test, a confirmatory step, and a treatment — and one (pheochromocytoma) has a rule that overrides everything: block the alpha receptors before you touch it. Master the screen-confirm-treat triad for each, plus the incidentaloma workup, and adrenal disease becomes orderly.
The framework: for each functional tumour — screen → confirm/localise → treat; then the incidentaloma algorithm (functional? malignant?).
Mechanism pathway
Tap any step to see why it happens.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Pheochromocytoma: screen with metanephrines; ALPHA-BLOCK FIRST, then beta-block, then adrenalectomy — never beta first (hypertensive crisis).
Always exclude pheochromocytoma before any adrenal surgery/biopsy.
Conn: hypertension + hypokalaemia → ARR (high aldosterone, low renin) → AVS (unilateral adenoma → surgery; bilateral → spironolactone).
Cushing: screen (1 mg dex suppression / midnight salivary / 24-h urinary cortisol) → ACTH to localise (low = adrenal → surgery; high = pituitary/ectopic).
Every incidentaloma: test for functionality (pheo, Cushing, ± Conn) and assess malignancy (size >4 cm, imaging); don't biopsy.