Disorders of the Adrenal Glands
The adrenal makes sense as soon as you map its anatomy to its diseases: each cortical layer secretes a different hormone, so each can over-secrete to produce a distinct syndrome, and the medulla has its own.
The big picture
The adrenal makes sense as soon as you map its anatomy to its diseases: each cortical layer secretes a different hormone, so each can over-secrete to produce a distinct syndrome, and the medulla has its own. So the diseases line up by layer — aldosterone (Conn's), cortisol (Cushing's), and catecholamines (phaeochromocytoma) — and the modern fourth problem is the incidentaloma, the mass found by accident on a scan done for something else.
The framework: disorders by source layer (the recall from anatomy: glomerulosa→mineralocorticoid, fasciculata→glucocorticoid, reticularis→sex steroid, medulla→catecholamine), how each is diagnosed, and how the incidentaloma is worked up.
Mechanism pathway
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The adrenal gland — cortical zones & medulla
The adrenal gland — cortical zones & medulla
From outside in: a capsule, then the cortex in three layers — zona glomerulosa (aldosterone), zona fasciculata (cortisol), zona reticularis (androgens) — wrapping the central medulla (catecholamines). The cortex is ~85% of the mass.
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Match the syndrome to the layer: glomerulosa→aldosterone (Conn's/hypertension), fasciculata→cortisol (Cushing's), medulla→catecholamines (phaeochromocytoma).
Cushing's screen = dexamethasone suppression, late-night salivary cortisol, or 24-h urinary free cortisol.
Phaeochromocytoma: diagnose with metanephrines/catecholamines; alpha-block before beta-block, before surgery.
Incidentaloma workup = functioning? + malignant? Low HU (≤10) favours benign.
Laparoscopic adrenalectomy is preferred except for very large/malignant masses.