ADRENAL MASS: Benign

ADRENAL MASS: Benign Benign Adrenal Mass Signs of Hormone Excess No Signs of Hormone Excess Hyperplasia Androgen Excess Estrogen ExcessAldosterone Excess Positive 24- Hour Metanephrines + Nor- Metanephrines Congenital Adrenal Hyperplasia ACTH Dependent ACTH Independent Macronodular Hyperplasia Glucocorticoid Releasing Adenoma (Positive Dexa-methasone Suppression Test) Hypertension +/- Hypokalemia/Alkalosis Aldosterone Releasing Adenoma (High Aldosterone: Renin Ratio) High DHEAS Normal DHEAS Androgen Releasing Adenoma Most common neoplasm is Benign Non-Functioning AdenomaNormal DHEAS Estrogen Releasing Adenoma (High Plasma E2 + Clinical Picture)Other Non-functioning Adenoma Lipoma Myelolipoma Ganglioneuroma Cyst Pseudocyst HematomaInfection (TB, Fungal)Amyloidosis Often Bilateral Glucocorticoid Excess Feminization, Early Puberty, Heavy Menses Pheochromocytoma (Paroxysmal Hypertension, Headache, Diaphoresis, Palpitations, Anxiety)Silent/Non-Functioning MassOther Source (e.g. Polycystic Ovarian Syndrome, Congenital Adrenal Hyperplasia)Virilization/ HirsutismCushingoid FeaturesRule of 10's For Pheochromocytoma:10% are Malignant10% are Bilateral10% are Extra-Adrenal10% are Familial10% are not Associated with Hypertension