Benign Adrenal Mass - Differential Diagnosis Algorithm

Hyperplasia - Often Bilateral

 • Congenital Adrenal Hyperplasia

 • ACTH Dependent

 • ACTH Independent

 • Macronodular Hyperplasia

Androgen Excess - Virilization / Hirsutism

 • High DHEAS

 • Low DHEAS

Estrogen Excess - Feminization, Early Puberty, Heavy Menses

 • Estrogen Releasing Adenoma (High Plasma E2 +Clinical Picture)

Glucocorticoid Excess - Cushingoid Features

 • Glucocorticoid Releasing Adenoma (Positive Dexamethasone Suppression Test)

Aldosterone Excess - Hypertension +/- Hypokalemia/Alkalosis

 • Aldosterone Releasing Adenoma (High Aldosterone:Renin Ratio)

Positive 24- Hour Metanephrine + Nor-Metanephrines

 • Pheochromocytoma (Paroxysmal Hypertension, Headache, Diaphoresis, Palpitations, Anxiety)

Silent/Non-Functioning Mass

 • Normal DHEAS

 • Other



#AdrenalMass #Benign #Differential #Diagnosis #Algorithm #Endocrinology