![]() 24-hour urinary free cortisol (measured twice)ĪCTH, adrenocorticotropic hormone CT, computed tomographyĪdrenal incidentaloma: A disease of imagingĪ new disease, ‘adrenal incidentaloma’, arose in the 1980s, became prevalent in the 1990s and is endemic this millennium.Midnight salivary cortisol (measured twice), or.1 mg overnight dexamethasone suppression test, or.To assess functionality, screen for Cushing’s syndrome, primary aldosteronism and phaeochromocytoma (see below).Dedicated adrenal CT scan to differentiate benign from malignant lesion.Initial investigations of adrenal disease In this commentary, the authors address the current state of the adrenal gland including the appropriate first-line investigations (Table 1). However, not all adrenal disease is uncommon: adrenal incidentalomas discovered on computed tomography (CT) scans are endemic 1 aldosterone excess contributes significantly to the burden of disease associated with hypertension 2 and the widespread use and misuse of glucocorticoids coupled with ready access to cortisol levels creates a novel set of clinical conundrums. Indeed, ‘headline acts’ such as adrenal carcinoma, phaeochromocytoma or Cushing’s syndrome are rare despite this, the possibility that they may be present continues to challenge clinicians. Adrenal diseases are generally considered to be uncommon. ![]()
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