Sandbox:Hannan

Cortex	Product	Clinical manifestations		Dianosis				Gold standard	Other features
		Symptoms	Signs	Blood & Urine	Histopathological	Imaging	Others
Adenoma	Aldosterone	Headache Vision problems Muscle cramps Muscle weakness & cramps Numbness Temporary paralysis Polyuria and polydipsia	Hypertension Refractory hypertension	Hypokalemia Alkalosis ↑ Plasma aldosterone ↓ Plasma Renin ↑ ARR	Single or multiple nodules Encapsulated Abundant clear cytoplasm Uniforming nuclei Histopathology may resemble: ZF (large, lipid-laden clear cells) ZG (small, compact cells with moderate amount of lipid) ZR (lipid-sparse cytoplasm)	Adrenal mass or nodule Unilateral or bilateral adrenal atrophy Hypodense mass (CT) Iso and low FDG uptake compared with liver (FDG PET/CT) Hyperintense on in-phase and hypointense on oppose-phase (MRI)	Fludrocortisone Suppression Testing Oral Sodium Loading Saline Infusion Testing Captopril test Adrenal venous sampling Posture test Genetic testing Immunohistochemical staining	Fludrocortisone Suppression Testing	Glucocorticoid-Remediable Aldosteronism responds to glucocorticoids Higher cardiovascular and cerebrovascular morbidity
	Cortisol	Weight gain Growth retardation Headaches Amenorrhea Virilization (rare) Acne Violaceous striae Acanthosis nigricans Sleep disruption Mental changes Muscular weakneness	Hypertension Hirsutism Hypogonadism Growth retardation Facial plethora Acne Striae Bruising Acanthosis nigricans Mental changes Muscular weakneness	↑ Plasma cortisol ↑ 24 Hour urinary cortisol ↓ or inappropriately normal plasma ACTH ↑ Blood glucose	Yellow fat Brown discoloration Large cells with increased lipid contetnt (zona fasciculata) May contain pigment (lipofuscin) Adjacent atrophied cells Hemorrhage and calcification (Pre-malignant lesions)	Adrenal mass or nodule Unilateral or bilateral adrenal atrophy ↑ Fat Hypodense mass (CT) Iso and low FDG uptake compared with liver (FDG PET/CT) Hyperintense on in-phase and hypointense on oppose-phase (MRI)	Diurnal plasma cortisol variation Low dose and high dose dexamethasone suppression test Dexamethasone-CRH test Adrenal venous sampling Genetic testing Immunohistochemical staining Dual-energy X-ray absorptiometry	N/A	Associated with Carney complex Associated with MEN-1 Plasma levels of cortisol and ACTH may show false positive and false negative results due to normal diurnal hormonal variation
	Androgens	Hirsutism Virilization Amenorrhea Precocious puberty Testicular atrophy & diminished libido (male)	Clitorimegaly Male pattern baldness Resistant hypertension Gynecomastia	↑ Serum testosterone ↑ Serum androstenedione ↑ Serum dehydroepiandrosterone sulfate (DHEA-S) ↑ urine 17-ketosteroids ↑ plasma and urine estrogens	Pale tan to brown Pseudocapsule or the fibrous capsule Nesting, alveolar, cords, trabeculae Eosinophilic cytoplasm May see clear, vacuolated cytoplasm	Well-defined Solid mass Homogeneous enhancement (CT contrast) Hyperintense on in-phase and hypointense on oppose-phase (MRI)	FSH, LH, prolactin levels Cortisol levels FDG PET/CT Pelvic Ultrasound Adrenal Venous sampling	N/A	Extremely rare Most androgen secreting adenomas are mixed tumors
	Non-functional	Asymptomatic Abdominal pain Abdominal distenstion Nausea/vomiting Sub-clinical Cushing syndrome Sub-clinical hyperaldosteroism	Asymptomatic Abdominal asymmetry Abdominal mass Sub-clinical Cushing syndrome Sub-clinical hyperaldosteroism	N/L ↓ Adrenal hormones ↑ Serum cortisol (sub-clinical) ↑ Serum aldosterone (sub-clinical) ↑ Serum androgens (sub-clinical)	Well-defined margins Large monomorphic cells Abundant/foamy cytoplasm Typically resemble normal adrenal histology May see hemorrhage & necrosis	Solid, well defined mass (ultrasound) High lipid content and adjacent compression (CT) Hyperintense on in-phase and hypointense on oppose-phase (MRI)	Adrenal hormone levels Blood glucose level Plasma catecholamines and urinary metanephrines ARR Immunohistochemical staining	N/A	2-fold increased risk for Diabetes mellitus in some studies Work up must exclude Cushing syndrome, pheochromocytoma and adrenal carcinoma
Carcinoma		Symptoms of adrenal hormones as mentioned in adrenal adenomas Constitutional symptoms such as cachexia, night sweats, fever Localized symptoms such as abdominal pain, mass, fullness, early satiety	Hypertension Signs of adrenal hormones as mentioned in adrenal adenomas Constitutional Localized signs such as abdominal mass,abdominal distension	N/L ↑ Serum cortisol ↑ Serum aldosterone ↑ Serum androgens Hypokalemia Alkalosis ↑ ARR ↑ Blood glucose	brown to orange to yellow Necrosis & mitosis Hypercellular & solid and/or diffuse growth pattern Low to high lipid content Nuclear pleomorphism Lymphovascular invasion	Heterogeneous enhancement (CT) Heterogenous hyper-intensity (T2-weighted) and hypo-intensity on (T1-weighted) (MRI) Heterogeneous mass with intense FDG uptake greater than liver ([18F]FDG PET/CT)	Serum ACTH Low dose and high dose dexamethasone Urinary adrenal metabolites Proton MR spectroscopy [11C]MTO PET Immunohistochemical staining	N/A	May cause hypoglycemia (Anderson's syndrome} May be associated with: hyperreninemic hyperaldosteronism, erythropoietin-associated polycythemia leukocytosis
Nodular Hyperplasia

Medulla	Product	Clinical manifestations		Dianosis				Gold standard	Other features
		Symptoms	Signs	Blood & Urine	Histopathological	Imaging	Others
Pheochromocytoma		Headaches Palpitations Excessive sweating Anxiety Pallor Pain in chest/abdomen Weakness, fatigue Nausea/vomiting Dizziness Paresthesias Constipation (rarely diarrhea) Visual disturbance
Neuroblastoma
Ganglioneuroma