Adrenal masses: Pathology review


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Adrenal masses: Pathology review


Adrenal gland disorders

Congenital adrenal hyperplasia

Primary adrenal insufficiency

Waterhouse-Friderichsen syndrome


Adrenal cortical carcinoma

Cushing syndrome

Conn syndrome

Thyroid gland disorders

Thyroglossal duct cyst


Graves disease

Thyroid eye disease (NORD)

Toxic multinodular goiter

Thyroid storm


Euthyroid sick syndrome

Hashimoto thyroiditis

Subacute granulomatous thyroiditis

Riedel thyroiditis

Postpartum thyroiditis

Thyroid cancer

Parathyroid gland disorders





Pancreatic disorders

Diabetes mellitus

Diabetic retinopathy

Diabetic nephropathy

Pituitary gland disorders


Pituitary adenoma






Growth hormone deficiency

Pituitary apoplexy

Sheehan syndrome


Constitutional growth delay

Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Gonadal dysfunction

Precocious puberty

Delayed puberty

Premature ovarian failure

Polycystic ovary syndrome

Androgen insensitivity syndrome

Kallmann syndrome

5-alpha-reductase deficiency

Polyglandular syndromes

Autoimmune polyglandular syndrome type 1 (NORD)

Endocrine tumors

Multiple endocrine neoplasia

Pancreatic neuroendocrine neoplasms

Zollinger-Ellison syndrome

Carcinoid syndrome



Opsoclonus myoclonus syndrome (NORD)

Endocrine system pathology review

Adrenal insufficiency: Pathology review

Adrenal masses: Pathology review

Hyperthyroidism: Pathology review

Hypothyroidism: Pathology review

Thyroid nodules and thyroid cancer: Pathology review

Parathyroid disorders and calcium imbalance: Pathology review

Diabetes mellitus: Pathology review

Cushing syndrome and Cushing disease: Pathology review

Pituitary tumors: Pathology review

Hypopituitarism: Pathology review

Diabetes insipidus and SIADH: Pathology review

Multiple endocrine neoplasia: Pathology review

Neuroendocrine tumors of the gastrointestinal system: Pathology review


Adrenal masses: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 15-month-old boy is brought to the clinic after his parents noticed frequent falls and abnormal twitching of his limbs over the past month. Prior to the onset of these symptoms, the patient had been walking without assistance and developing normally. Vital signs are within normal limits. Physical examination shows bilateral jerking eye movements and sporadic muscle contractions of the trunk and limbs. The patient has difficulty walking in a straight line and stumbles several times. A left-sided abdominal mass is palpated. Biopsy of the mass reveals small, round, blue cells arranged concentrically around a central neuropil. Staining with neuron-specific enolase is positive. Based on these findings, which of the following is most likely to be elevated?  


Content Reviewers

Yifan Xiao, MD


Jung Hee Lee, MScBMC

Salma Ladhani, MD

Daniel Afloarei, MD

Sam Gillespie, BSc

While doing your rounds, you see two individuals. First is Jessica, who comes in with lumbar pain, anuria, and constipation. Examination is unremarkable and she doesn’t have any history of kidney disease. The other person is 38-year-old Dan, who is obese and has an abnormally round face. He is also hypertensive and hyperglycemic. Dan is not taking any medications but he’s complaining of severe lumbar pain on the left side. Abdominal CT scans were obtained for both. In Jessica’s case, imaging detected a mass in the right adrenal cortex. In Dan’s case, CT detected a mass in the left adrenal cortex.

Ok, so both seem to have some type of adrenal masses. But first, a little bit of physiology. Each adrenal gland has two main components: the cortex and the medulla. For your exam, something high-yield to keep in mind is that the cortex is composed of 3 zones. The zona glomerulosa, the outer zone, contains clustered cells that produce mineralocorticoids, mainly aldosterone, which regulates blood pressure and electrolyte balance. The zona fasciculata, the middle zone, contains foamy-looking cells in columns that are responsible for the production of glucocorticoids, predominantly cortisol, which increases blood sugar levels via gluconeogenesis, suppresses the immune system, and aids in metabolism. And the innermost zone is the zona reticularis, which has basophilic cells arranged in anastomosing cords that produce gonadocorticoids, especially androgens like dehydroepiandrosterone or DHEA.

The medulla is composed of special cells called chromaffin cells. These are modified postganglionic sympathetic neurons that originate from the neural crest. Normally, when a fetus is in its 5th week of development, special cells called neural crest cells start migrating along the midline of the embryo. In the thoracic region, neural crest cells differentiate into the neurons of the sympathetic chain on either side of the developing spinal cord. In the lumbar region, neural crest cells differentiate into the cells of the adrenal medulla.


Adrenal masses are abnormal growths or lumps on the adrenal glands. The most common type of adrenal mass is a non-cancerous (benign) tumor, but several types of cancer can occur in the adrenal glands.

The symptoms of an adrenal mass depend on its size and location. Smaller tumors may not cause any symptoms, while larger tumors can cause pain, pressure, or other problems depending on their location.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Greenspan's Basic and Clinical Endocrinology, Tenth Edition" McGraw-Hill Education / Medical (2017)
  6. "Pathophysiology of Dyslipidemia in Cushing’s Syndrome" Neuroendocrinology (2010)

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