Endocrinological diagnostic process investigating hormone excess or deficiency originating from the adrenal glands through laboratory tests and advanced imaging.
Indication
- Unexplained weight gain, moon face appearance, purple stretch marks (suspected Cushing syndrome)
- Fatigue, weight loss, skin darkening, low blood pressure (suspected Addison disease)
- High blood pressure attacks with palpitations, sweating, headache (suspected pheochromocytoma)
- Treatment-resistant hypertension, low potassium (suspected primary hyperaldosteronism)
- Adrenal mass detected incidentally on imaging (incidentaloma)
- Hypertension at a young age or family history of adrenal disease
- Sexual development disorders, precocious puberty
Preparation
- Patient should arrive fasting in the morning, with blood drawn at a specific time for baseline cortisol
- Medications such as glucocorticoids, estrogens, and antihypertensives are adjusted with physician guidance
- A 24-hour urine collection container is provided in advance for urine tests
- Heavy stress, smoking, and caffeine are limited before the test
- Previous imaging and tests are shared with the physician
How it's performed
- Detailed history and physical examination; blood pressure, pulse, and body composition are evaluated
- Baseline cortisol, ACTH, DHEA-S, aldosterone, renin, plasma metanephrine/normetanephrine measurements are performed
- When Cushing is suspected, 1 mg overnight dexamethasone suppression test, late-night salivary cortisol, and 24-hour urinary free cortisol are requested
- When Addison is suspected, ACTH stimulation (Synacthen) test is planned
- Imaging includes contrast-enhanced computed tomography (CT) or MRI to examine the adrenal glands
- When necessary, venous sampling or nuclear medicine examinations are arranged at a tertiary center
Post-procedure
- Follow-up every 3-6 months after treatment in cases with hormone excess
- Glucocorticoid and, if needed, mineralocorticoid replacement is regularly monitored in adrenal insufficiency
- In incidentaloma follow-up, imaging and hormonal tests are repeated in the first year
- Long-term monitoring for hormonal deficiency or recurrence in postsurgical patients
- Multidisciplinary collaboration in patients with hypertension or electrolyte disturbance
Risks
- Allergic reaction to contrast imaging and effects on kidney function
- Hypotension or weakness during testing in adrenal insufficiency
- Blood pressure fluctuations during testing in suspected pheochromocytoma
- Unnecessary further investigation due to false positive test results
- General surgical risks of adrenal surgery when surgery is required
FAQ
An adrenal mass was found — does it always mean cancer?
No. The vast majority of incidentally detected adrenal masses are benign adenomas. Cancer risk is determined by evaluating size, imaging features, and hormonal activity.
How is a 24-hour urine collection done?
The first morning urine is discarded; over the next 24 hours, all urine is collected in the provided container, finishing with the first urine of the next morning. The container is kept refrigerated throughout.
What is the treatment for Cushing syndrome?
It depends on the cause. If due to corticosteroid medication, the dose is reduced; if caused by an adrenal or pituitary tumor, options such as surgery, medication, or radiotherapy are considered.
Does Addison disease last for life?
Mostly yes. Hormone replacement therapy is continued for life, with dose adjustments particularly during stress, infection, or surgery.
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