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Adrenal gland
A Contemporary Approach to the Diagnosis and Management of Adrenal Insufficiency
Suranut Charoensri, Richard J. Auchus
Endocrinol Metab. 2024;39(1):73-82.   Published online January 22, 2024
DOI: https://doi.org/10.3803/EnM.2024.1894
  • 109,257 View
  • 2,400 Download
  • 17 Web of Science
  • 22 Crossref
AbstractAbstract PDFPubReader   ePub   
Adrenal insufficiency (AI) can be classified into three distinct categories based on its underlying causes: primary adrenal disorders, secondary deficiencies in adrenocorticotropin, or hypothalamic suppression from external factors, most commonly glucocorticoid medications used for anti-inflammatory therapy. The hallmark clinical features of AI include fatigue, appetite loss, unintentional weight loss, low blood pressure, and hyponatremia. Individuals with primary AI additionally manifest skin hyperpigmentation, hyperkalemia, and salt craving. The diagnosis of AI is frequently delayed due to the non-specific symptoms and signs early in the disease course, which poses a significant challenge to its early detection prior to an adrenal crisis. Despite the widespread availability of lifesaving glucocorticoid medications for decades, notable challenges persist, particularly in the domains of timely diagnosis while simultaneously avoiding misdiagnosis, patient education for averting adrenal crises, and the determination of optimal replacement therapies. This article reviews recent advancements in the contemporary diagnostic strategy and approaches to optimal treatment for AI.

Citations

Citations to this article as recorded by  
  • Determining the comparative pharmacodynamic equivalence of a non-invasive diagnostic test for patients with adrenal insufficiency using a randomised 2-way crossover trial: the STARLIT-3 study protocol
    Kathryn Date, Kathleen Baster, Sharon Caunt, Judith Cohen, Miguel Debono, Jane Fearnside, Trevor N Johnson, Peter Laud, Richard J Ross, Rosie Taylor, Charlotte Jane Elder
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  • Post-ACTH peak cortisol response is associated with genotype in children with nonclassic congenital adrenal hyperplasia
    Allie N. Dayno, Marissa J. Kilberg, Erin Gonter, Robert Gallop, Jacob Squicciarini, Carolina Montano, Maria G. Vogiatzi
    Frontiers in Endocrinology.2026;[Epub]     CrossRef
  • Metabolic Effects of Modified‐Release Hydrocortisone Versus Short Acting Conventional Oral Glucocorticoids in Adrenal Insufficiency: A Systematic Review and Meta‐Analysis
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    Clinical Endocrinology.2026; 105(3): 285.     CrossRef
  • Adrenal insufficiency diagnosis: new approaches to indeterminate baseline cortisol
    Maria Ortega, Natalia Fretes Oviedo, Ricardo Correa
    Current Opinion in Endocrinology, Diabetes & Obesity.2026; 33(5): 200.     CrossRef
  • The Effect of Whitening Creams Usage on the Adrenal Gland 
    Fadheelah Salman Azeez, Noor Faisal Noaman, Ahmed Neema AL-Mussawy
    F1000Research.2026; 14: 1434.     CrossRef
  • Hyponatremia as the Initial Presentation of Rathke’s Cleft Cyst-Related Hypopituitarism
    Naung Latt Htun, Aye Nyein Thinzar, Hsan Theingi Win, Dilip Joseph Thottacherry
    Cureus.2026;[Epub]     CrossRef
  • An Unrecognized Cause of Chronic Diarrhea: Opioid-Induced Adrenal Insufficiency – A Case Report
    David Kweku Aseda Donkor, Rejoice Abiodun, Parth Adrejiya, Winston Ugbajah, Cyril Anara
    Journal of Pain & Palliative Care Pharmacotherapy.2026; : 1.     CrossRef
  • Hemodynamic management, including for left ventricular outflow tract obstruction, in an infant with ACTH-independent Cushing syndrome undergoing adrenal tumor removal: a case report
    Mariko Saito, Maiko Hosokawa, Kenichi Masui
    JA Clinical Reports.2026;[Epub]     CrossRef
  • Primary adrenal lymphoma presenting as primary adrenal insufficiency
    Khaled Ahmed, Efstratios Stratos, Louis Saada, Joel Cunningham, Khin S Myint
    BMJ Case Reports.2026; 19(9): e269999.     CrossRef
  • Adrenal insufficiency in severely wounded men with combat gunshot injury
    N.Yu. Seliukova, K.V. Misiura, E.M. Khoroshun, V.V. Makarov, V.V. Nehoduiko, O.I. Zalyubovska, E. Szucsik
    INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2025; 20(8): 573.     CrossRef
  • A deep learning algorithm for automated adrenal gland segmentation on non-contrast CT images
    Fanxing Meng, Tuo Zhang, Yukun Pan, Xiaojing Kan, Yuwei Xia, Mengyuan Xu, Jin Cai, Fangbin Liu, Yinghui Ge
    BMC Medical Imaging.2025;[Epub]     CrossRef
  • Metabolic and endocrine dysfunctions in traumatic brain injury: Implications for cognitive recovery and therapeutic strategies
    Jigar Manilal Haria, Naveen Kumar Singh, Jayballabh Kumar, Sanjeev Kumar Jain, DattaSai Pamidimarri
    Behavioural Brain Research.2025; 493: 115697.     CrossRef
  • Recurrent Hyponatremia Mimicking Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Case of Partial Empty Sella Syndrome With Isolated Adrenocorticotropic Hormone Deficiency
    Revathi Rajendran, Amirthalingeswaran Govindan
    Cureus.2025;[Epub]     CrossRef
  • Management of Primary Adrenal Insufficiency and Overt Hypothyroidism in an HIV‐Positive Patient in a Resource‐Limited Setting: A Case Report
    Majani Edward, Witness John, Dominick M. Raphael
    Clinical Case Reports.2025;[Epub]     CrossRef
  • A practical approach to diagnosis and treatment in children with primary adrenal insufficiency
    Donatella Capalbo, Sara Illiano, Sara Vasaturo, Paola Lorello, Francesca Romana Rotondo, Raffaella Di Mase, Carla Bizzarri, Mariacarolina Salerno
    European Journal of Endocrinology.2025; 193(5): R45.     CrossRef
  • The Effect of Whitening Creams Usage on the Adrenal Gland 
    Fadheelah Salman Azeez, Noor Faisal Noaman, Ahmed Neema AL-Mussawy
    F1000Research.2025; 14: 1434.     CrossRef
  • Unintentional discontinuation of topical corticosteroids after emergency hospitalization can exacerbate adrenal insufficiency
    Hiroya Kitsunai, Yumika Watanabe, Eisuke Nishikawa, Fumika Maruyama, Hiroshi Nomoto
    Endocrine Journal.2025; 72(12): 1377.     CrossRef
  • Diagnostic pharmacology: Drugs that uncover diseases
    K. Saranraj, Gollapudi Poojitha Siri Chandana
    National Journal of Pharmacology and Therapeutics.2025; 3(3): 197.     CrossRef
  • Post-Traumatic Hypopituitarism
    Nissa Blocher
    Current Physical Medicine and Rehabilitation Reports.2024; 12(4): 405.     CrossRef
  • Severe Fatigue in Uncontrolled Asthma: Contributing Factors and Impact of Rehabilitation
    Karin B. Fieten, Lianne ten Have, Linde N. Nijhof, Lucia Rijssenbeek-Nouwens, Anneke ten Brinke
    The Journal of Allergy and Clinical Immunology: In Practice.2024; 12(12): 3292.     CrossRef
  • Adrenal Insufficiency in Patients with Beta Thalassemia: A Meta-Analysis
    Christos Savvidis, Dimitra Ragia, Sophia Delicou, Aikaterini Xydaki, Manfredi Rizzo, Ioannis Ilias
    Medicina.2024; 60(10): 1571.     CrossRef
  • 長期間の呼吸管理および遷延する低血圧から診断に至ったACTH単独欠損症の1例(A case of isolated ACTH deficiency diagnosed after long–term respiratory management and persistent hypotension)
    古谷 慎太郎, 神山 治郎, 多喜 亘, 山本 大輔, 五木田 昌士, 田口 茂正, 清田 和也
    Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine.2024; 35(12): 965.     CrossRef
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Adrenal Gland
Recent Updates on the Management of Adrenal Incidentalomas
Seung Shin Park, Jung Hee Kim
Endocrinol Metab. 2023;38(4):373-380.   Published online August 16, 2023
DOI: https://doi.org/10.3803/EnM.2023.1779
  • 58,488 View
  • 3,526 Download
  • 25 Web of Science
  • 30 Crossref
AbstractAbstract PDFPubReader   ePub   
Adrenal incidentalomas represent an increasingly common clinical conundrum with significant implications for patients. The revised 2023 European Society of Endocrinology (ESE) guideline incorporates cutting-edge evidence for managing adrenal incidentalomas. This paper provides a concise review of the updated contents of the revised guideline. In the 2023 guideline, in patients without signs and symptoms of overt Cushing’s syndrome, a post-dexamethasone cortisol level above 50 nmol/L (>1.8 μg/dL) should be considered as mild autonomous cortisol secretion. Regarding the criteria of benign adrenal adenomas, a homogeneous adrenal mass with ≤10 Hounsfield units on non-contrast computed tomography requires no further follow-up, irrespective of its size. The updated guideline also discusses steroid metabolomics using tandem mass spectrometry to discriminate malignancy. It underscores the importance of high-volume surgeons performing adrenalectomy and emphasizes the pivotal role of a multidisciplinary team approach in deciding the treatment plan for indeterminate adrenal masses. The guideline advocates for more proactive surgical treatment for indeterminate adrenal masses in young patients (<40 years) and pregnant women. This review of the 2023 ESE guideline underscores the ongoing evolution of the adrenal incidentaloma management landscape, emphasizing the need for further research and adaptation of diagnostic and therapeutic strategies.

Citations

Citations to this article as recorded by  
  • The Relationship Between Bone Health Status of Post-Menopausal Women with Non-Functional Adrenal Tumours/Mild Autonomous Cortisol Secretion and Their Baseline Morning Adrenocorticotropic Level
    Alexandra-Ioana Trandafir, Oana-Claudia Sima, Nina Ionovici, Dana Manda, Mihai Costachescu, Mara Carsote
    Diagnostics.2026; 16(2): 180.     CrossRef
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    Endocrine.2026;[Epub]     CrossRef
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    Michał Szklarz, Katarzyna Wołos-Kłosowicz, Julia Modzelewska, Jan Górny, Robert Modzelewski, Wojciech Matuszewski
    European Journal of Medical Research.2026;[Epub]     CrossRef
  • Predictive Model for Mild Autonomous Cortisol Secretion in Patients Evaluated in Artificial Intelligence–Driven Adrenal Incidentaloma Clinic
    Mehmet Kostek, Chandler McLeod, Julia Kasmirski, Haleigh Negrete, Srini Tridandapani, Micah Cochran, John D Osborne, Andrea Gillis, Herbert Chen, Brenessa Lindeman
    Journal of the American College of Surgeons.2026; 242(5): 1290.     CrossRef
  • Plasma proteomic profiling identifies apolipoprotein A4 as a downregulated biomarker of adrenocortical carcinoma: a multi-platform discovery and validation study
    Seung Shin Park, Hoseok Seo, Sun Joon Moon, Han Na Jang, Seung Hun Lee, Su-jin Kim, Kyu Eun Lee, Dohyun Han, Jung Hee Kim
    European Journal of Endocrinology.2026; 194(5): 641.     CrossRef
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    Frontiers in Endocrinology.2026;[Epub]     CrossRef
  • Glucocorticoid replacement duration after unilateral adrenalectomy for mild autonomous cortisol secretion and adrenal Cushing syndrome: a multicenter cohort study
    You-Bin Lee, Seung Shin Park, Min Jeong Park, Jeongmin Lee, A Ram Hong, Eu Jeong Ku, Seong Hee Ahn, Kyong Yeun Jung, Ju Hee Lee, Hyo-Jeong Kim, Jung Hee Kim, Seung Hun Lee
    European Journal of Endocrinology.2026; 195(3): 498.     CrossRef
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    Fanxing Meng, Tuo Zhang, Yukun Pan, Xiaojing Kan, Yuwei Xia, Mengyuan Xu, Jin Cai, Fangbin Liu, Yinghui Ge
    BMC Medical Imaging.2025;[Epub]     CrossRef
  • A Secret Revealed: The Coexistence of a Pheochromocytoma and Independent Adrenocorticotropic Hormone-Secreting Cushing Syndrome Within the Same Adrenal Gland
    Sana Rafi, Meryam Alahyane, Ghizlane Elmghari, Nawal El Ansari, Fatim Zahra Hazmiri, Oumayma Ait Ouhssain, Hanane Rais
    Cureus.2025;[Epub]     CrossRef
  • The Landmark Series: Evaluation and Management of Adrenal Incidentalomas
    Lily Owei, Heather Wachtel
    Annals of Surgical Oncology.2025; 32(7): 4712.     CrossRef
  • Management of adrenal incidentalomas: who, why and how?
    Marta Araujo-Castro, María Bernarda Iriarte-Durán, Paola Parra-Ramírez, Sara Donato
    Current Opinion in Endocrinology, Diabetes & Obesity.2025; 32(5): 210.     CrossRef
  • Changing paradigms in evaluating adrenal incidentalomas: Bayesian evaluation of [18F]Fluorodeoxyglucose positron emission tomography use, honed on adrenocortical carcinoma
    Ioannis Ilias, Georgios Meristoudis
    World Journal of Clinical Oncology.2025;[Epub]     CrossRef
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    Ines Harper, Ashley S Shaw, HK Cheow
    Medicine.2025; 53(9): 559.     CrossRef
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    Alicija Krasavceva, Juozas Jarašūnas, Donatas Jocius, Romena Laukienė, Žydrūnė Visockienė, Virgilijus Beiša
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    Xiaowen Xu, Yingjie Shen, Jingjing Jiang, Yingxian Pang, Kai Cheng, Zhi Li, Yizhou Wang, Junjie Chen, Anze Yu, Jing Wang, Minghao Li, Jing Zhang, Longfei Liu
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  • Dexamethasone Suppression Testing in Patients with Adrenal Incidentalomas with/Without Mild Autonomous Cortisol Secretion: Spectrum of Cortisol Cutoffs and Additional Assays (An Updated Analysis)
    Alexandra-Ioana Trandafir, Mara Carsote
    Biomedicines.2025; 13(9): 2169.     CrossRef
  • Update of the guidelines on the management of adrenal incidentaloma from the adrenal group of the Spanish society of endocrinology and nutrition (SEEN)
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    Vnitřní lékařství.2024; 70(5): E9.     CrossRef
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    Claudiu Nistor, Mihai-Lucian Ciobica, Oana-Claudia Sima, Anca-Pati Cucu, Florina Vasilescu, Lucian-George Eftimie, Dana Terzea, Mihai Costachescu, Adrian Ciuche, Mara Carsote
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    Endocrinology and Metabolism.2024; 39(6): 965.     CrossRef
Close layer
Original Article
Adrenal Gland
Adrenal Morphology as an Indicator of Long-Term Disease Control in Adults with Classic 21-Hydroxylase Deficiency
Taek Min Kim, Jung Hee Kim, Han Na Jang, Man Ho Choi, Jeong Yeon Cho, Sang Youn Kim
Endocrinol Metab. 2022;37(1):124-137.   Published online February 8, 2022
DOI: https://doi.org/10.3803/EnM.2021.1278
  • 9,504 View
  • 150 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
Monitoring adults with classical 21-hydroxylase deficiency (21OHD) is challenging due to variation in clinical and laboratory settings. Moreover, guidelines for adrenal imaging in 21OHD are not yet available. We evaluated the relationship between adrenal morphology and disease control status in classical 21OHD.
Methods
This retrospective, cross-sectional study included 90 adult 21OHD patients and 270 age- and sex-matched healthy controls. We assessed adrenal volume, width, and tumor presence using abdominal computed tomography and evaluated correlations of adrenal volume and width with hormonal status. We investigated the diagnostic performance of adrenal volume and width for identifying well-controlled status in 21OHD patients (17α-hydroxyprogesterone [17-OHP] <10 ng/mL).
Results
The adrenal morphology of 21OHD patients showed hypertrophy (45.6%), normal size (42.2%), and hypotrophy (12.2%). Adrenal tumors were detected in 12 patients (13.3%). The adrenal volume and width of 21OHD patients were significantly larger than those of controls (18.2±12.2 mL vs. 7.1±2.0 mL, 4.7±1.9 mm vs. 3.3±0.5 mm, P<0.001 for both). The 17-OHP and androstenedione levels were highest in patients with adrenal hypertrophy, followed by those with normal adrenal glands and adrenal hypotrophy (P<0.05 for both). Adrenal volume and width correlated positively with adrenocorticotropic hormone, 17-OHP, 11β-hydroxytestosterone, progesterone sulfate, and dehydroepiandrosterone sulfate in both sexes (r=0.33–0.95, P<0.05 for all). For identifying well-controlled patients, the optimal cut-off values of adrenal volume and width were 10.7 mL and 4 mm, respectively (area under the curve, 0.82–0.88; P<0.001 for both).
Conclusion
Adrenal volume and width may be reliable quantitative parameters for monitoring patients with classical 21OHD.

Citations

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Close layer
Review Article
Adrenal gland
Embryonic Development and Adult Regeneration of the Adrenal Gland
Ji-Hoon Kim, Man Ho Choi
Endocrinol Metab. 2020;35(4):765-773.   Published online December 23, 2020
DOI: https://doi.org/10.3803/EnM.2020.403
  • 27,382 View
  • 749 Download
  • 34 Web of Science
  • 36 Crossref
AbstractAbstract PDFPubReader   ePub   
The adrenal gland plays a pivotal role in an organism’s health span by controlling the endocrine system. Decades of research on the adrenal gland have provided multiscale insights into the development and maintenance of this essential organ. A particularly interesting finding is that founder stem/progenitor cells participate in adrenocortical development and enable the adult adrenal cortex to regenerate itself in response to hormonal stress and injury. Since major advances have been made in understanding the dynamics of the developmental process and the remarkable regenerative capacity of the adrenal gland, understanding the mechanisms underlying adrenal development, maintenance, and regeneration will be of interest to basic and clinical researchers. Here, we introduce the developmental processes of the adrenal gland and discuss current knowledge regarding stem/progenitor cells that regulate adrenal cortex remodeling and regeneration. This review will provide insights into the fascinating ongoing research on the development and regeneration of the adrenal cortex.

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Case Report
A Case Report of Bilateral Adrenocortical Carcinoma Complicated by Adrenal Insufficiency.
Min Joo Kim, Jung Hee Kim, Tae Young Kim, Sang Wan Kim
Endocrinol Metab. 2011;26(3):243-247.   Published online September 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.3.243
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AbstractAbstract PDF
Adrenocortical carcinoma is often functional and presents with signs and symptoms of adrenal steroid hormone excess. Adrenal insufficiency secondary to bilateral adrenocortical carcinoma is a particularly rare complication. We recently encountered a case of bilateral adrenocortical carcinoma complicated by adrenal insufficiency. A 52-year-old male was transferred to this hospital complaining of general weakness and weight loss. A bilateral adrenal mass was detected on abdomen CT. Plasma cortisol and aldosterone failed to rise during the rapid ACTH stimulation test. The CT-guided adrenal biopsy revealed findings consistent with adrenocortical carcinoma. Left hemiparesis was developed and brain metastasis was detected via brain MRI. Despite the application of gamma knife surgery and chemotherapy, the disease progressed and the patient died.

Citations

Citations to this article as recorded by  
  • Bilateral Adrenocortical Carcinoma Presenting as Acute Adrenal Insufficiency
    Anshita Aggarwal, Aprajita Verma, Aparajita Roy, Bindu Kulshreshtha
    European Endocrinology.2020; 16(2): 172.     CrossRef
  • A Case of Bilateral ACTH-independent Adrenal Adenomas with Cushing's Syndrome Treated by Ipsilateral Total and Contralateral Partial Laparoscopic Adrenalectomy
    Seung Ah Park, Dong min Jung, Soon young Kim, Nan Young Choi, Tae-jun Kim, Yong kyun Kim, Seong kyun Na, Chul Sik Kim, Seong Jin Lee, Sung-Hee Ihm, Jun Goo Kang
    The Korean Journal of Obesity.2013; 22(4): 254.     CrossRef
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