Sandbox:Hannan


Cortex	Product	Clinical manifestations		Dianosis				Gold standard	Other features
Cortex	Product	Symptoms	Signs	Blood & Urine	Histopathological	Imaging	Others	Gold standard	Other features
Adenoma	Aldosterone^[1]^[2]^[3]^[4]	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^[1]^[5]^[6]^[7]	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^[4]^[8]	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
	Mix
Carcinoma
Nodular Hyperplasia


Adrenal mass	Clinical manifestations		Diagnosis				Gold standard	Other features
Adrenal mass	Symptoms	Signs	Blood & Urine	Histopathological	Imaging	Others	Gold standard	Other features

References

↑ ^1.0 ^1.1 Park JJ, Park BK, Kim CK (June 2016). "Adrenal imaging for adenoma characterization: imaging features, diagnostic accuracies and differential diagnoses". Br J Radiol. 89 (1062): 20151018. doi:10.1259/bjr.20151018. PMC 5258164. PMID 26867466.
↑ Monticone S, Castellano I, Versace K, Lucatello B, Veglio F, Gomez-Sanchez CE, Williams TA, Mulatero P (August 2015). "Immunohistochemical, genetic and clinical characterization of sporadic aldosterone-producing adenomas". Mol. Cell. Endocrinol. 411: 146–54. doi:10.1016/j.mce.2015.04.022. PMC 4474471. PMID 25958045.
↑ Stowasser M, Taylor PJ, Pimenta E, Ahmed AH, Gordon RD (May 2010). "Laboratory investigation of primary aldosteronism". Clin Biochem Rev. 31 (2): 39–56. PMC 2874431. PMID 20498828.
↑ ^4.0 ^4.1 Guerrisi A, Marin D, Baski M, Guerrisi P, Capozza F, Catalano C (2013). "Adrenal lesions: spectrum of imaging findings with emphasis on multi-detector computed tomography and magnetic resonance imaging". J Clin Imaging Sci. 3: 61. doi:10.4103/2156-7514.124088. PMC 3935261. PMID 24605256.
↑ Stratakis CA (2008). "Cushing syndrome caused by adrenocortical tumors and hyperplasias (corticotropin- independent Cushing syndrome)". Endocr Dev. 13: 117–32. doi:10.1159/000134829. PMC 3132884. PMID 18493137.
↑ Zilbermint M, Stratakis CA (June 2015). "Protein kinase A defects and cortisol-producing adrenal tumors". Curr Opin Endocrinol Diabetes Obes. 22 (3): 157–62. doi:10.1097/MED.0000000000000149. PMC 4560837. PMID 25871963.
↑ Wei J, Li S, Liu Q, Zhu Y, Wu N, Tang Y, Li Q, Ren K, Zhang Q, Yu Y, An Z, Chen J, Li J (April 2018). "ACTH-independent Cushing's syndrome with bilateral cortisol-secreting adrenal adenomas: a case report and review of literatures". BMC Endocr Disord. 18 (1): 22. doi:10.1186/s12902-018-0250-6. PMC 5913873. PMID 29685132.
↑ Arnold DT, Reed JB, Burt K (January 2003). "Evaluation and management of the incidental adrenal mass". Proc (Bayl Univ Med Cent). 16 (1): 7–12. PMC 1200803. PMID 16278716.

[pmid26867466-1] 1.0 ^1.1 Park JJ, Park BK, Kim CK (June 2016). "Adrenal imaging for adenoma characterization: imaging features, diagnostic accuracies and differential diagnoses". Br J Radiol. 89 (1062): 20151018. doi:10.1259/bjr.20151018. PMC 5258164. PMID 26867466.

[pmid25958045-2] Monticone S, Castellano I, Versace K, Lucatello B, Veglio F, Gomez-Sanchez CE, Williams TA, Mulatero P (August 2015). "Immunohistochemical, genetic and clinical characterization of sporadic aldosterone-producing adenomas". Mol. Cell. Endocrinol. 411: 146–54. doi:10.1016/j.mce.2015.04.022. PMC 4474471. PMID 25958045.

[pmid20498828-3] Stowasser M, Taylor PJ, Pimenta E, Ahmed AH, Gordon RD (May 2010). "Laboratory investigation of primary aldosteronism". Clin Biochem Rev. 31 (2): 39–56. PMC 2874431. PMID 20498828.

[pmid24605256-4] 4.0 ^4.1 Guerrisi A, Marin D, Baski M, Guerrisi P, Capozza F, Catalano C (2013). "Adrenal lesions: spectrum of imaging findings with emphasis on multi-detector computed tomography and magnetic resonance imaging". J Clin Imaging Sci. 3: 61. doi:10.4103/2156-7514.124088. PMC 3935261. PMID 24605256.

[pmid18493137-5] Stratakis CA (2008). "Cushing syndrome caused by adrenocortical tumors and hyperplasias (corticotropin- independent Cushing syndrome)". Endocr Dev. 13: 117–32. doi:10.1159/000134829. PMC 3132884. PMID 18493137.

[pmid25871963-6] Zilbermint M, Stratakis CA (June 2015). "Protein kinase A defects and cortisol-producing adrenal tumors". Curr Opin Endocrinol Diabetes Obes. 22 (3): 157–62. doi:10.1097/MED.0000000000000149. PMC 4560837. PMID 25871963.

[pmid29685132-7] Wei J, Li S, Liu Q, Zhu Y, Wu N, Tang Y, Li Q, Ren K, Zhang Q, Yu Y, An Z, Chen J, Li J (April 2018). "ACTH-independent Cushing's syndrome with bilateral cortisol-secreting adrenal adenomas: a case report and review of literatures". BMC Endocr Disord. 18 (1): 22. doi:10.1186/s12902-018-0250-6. PMC 5913873. PMID 29685132.

[pmid16278716-8] Arnold DT, Reed JB, Burt K (January 2003). "Evaluation and management of the incidental adrenal mass". Proc (Bayl Univ Med Cent). 16 (1): 7–12. PMC 1200803. PMID 16278716.

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Sandbox:Hannan

References

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