Adrenal Diseases

Reviewed by Alexander Shifrin, MD, Surgical Director of Endocrinology, Atlantic Health CentraState Medical Center, Freehold, NJ.

The adrenal glands are two small glands that sit on top of the kidneys. They make cortisol, aldosterone, and adrenaline-type hormones. Most adrenal tumors are benign and many never need surgery. Some make too much hormone and cause high blood pressure, weight gain, or spells of pounding heart and sweating. A few are cancer. The first job is to find out which kind you have. Dr. Shifrin performs adrenal surgery, mostly through the back with a minimally invasive approach, and accepts referrals from endocrinologists, primary care doctors, cardiologists, nephrologists, radiologists and urologists.

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Types of adrenal diseaseHow adrenal disease is foundWhen surgery is neededFor referring doctorsQuestionsGuidelines

Types of adrenal disease

Condition What it is Signs Usual treatment
Adrenal incidentaloma A mass found by chance on a CT, MRI, or ultrasound done for another reason. Most are benign and do not make extra hormone. Often none Imaging and hormone tests first. Many are only watched. Surgery if the mass makes hormone or looks suspicious.
Primary aldosteronism (Conn syndrome) The adrenal makes too much aldosterone. High blood pressure, sometimes low potassium, hard-to-control blood pressure Surgery if one gland is the cause. Medicine if both glands are involved.
Cushing syndrome / cortisol excess Too much cortisol. An adrenal tumor can be the cause. Weight gain in the trunk and face, purple stretch marks, easy bruising, high blood pressure, high blood sugar, bone loss Surgery when an adrenal tumor makes the cortisol. Steroid replacement is needed for a time afterward.
Pheochromocytoma / paraganglioma A tumor that makes adrenaline-type hormones (catecholamines). Spells of headache, sweating, and pounding heart; high or swinging blood pressure Surgery after medicines that block the hormone effects. Genetic testing is advised.
Adrenocortical carcinoma Adrenal cancer. Rare. A large mass, hormone excess, or belly pain Surgery by an experienced adrenal surgeon, often with further treatment. Reviewed by a team.
Other masses Myelolipoma (benign fatty tumor), cysts, and cancer that has spread to the adrenal from elsewhere. Often none Many are watched. Surgery for large or symptomatic masses, or when the diagnosis is unclear.
Congenital adrenal hyperplasia An inherited enzyme problem, usually found in childhood. Varies with type Treated mainly with medicine by endocrinologists. Surgery only in selected cases.

Primary aldosteronism specialist listing. Dr. Shifrin is listed in the Primary Aldosteronism Foundation directory of specialists for the diagnosis and surgical treatment of primary aldosteronism. See his listing →

How adrenal disease is found

Two questions guide everything: does the mass make hormone, and does it look like cancer?

1. Mass or symptoms
Found on imaging, or high blood pressure that is hard to control
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2. Imaging
Size and appearance on CT or MRI
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3. Hormone tests
Blood, urine, or saliva tests for cortisol, aldosterone, and metanephrines
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4. Decision
Watch, treat with medicine, or operate

Not every test is needed for every person. Which tests you need depends on how the mass looks on imaging and on your blood pressure, potassium, and symptoms. Do not have a biopsy of an adrenal mass before pheochromocytoma has been ruled out.

When surgery is needed

Surgery is usually advised Watching is often enough
A mass that makes too much aldosterone, cortisol, or adrenaline-type hormone from one gland
A pheochromocytoma
A mass that looks suspicious for cancer or keeps growing
A large or symptomatic mass		 A small mass that looks benign on imaging and makes no extra hormone
A myelolipoma or cyst without symptoms

Most adrenal operations can be done through small incisions. The posterior retroperitoneoscopic approach reaches the gland through the back. See Adrenal Surgery for how the operation is done, risks, and recovery.

Get urgent care (call 911) for a sudden severe headache with very high blood pressure, chest pain, fainting, or severe weakness with vomiting. These can happen with some adrenal conditions, and they can also have other causes.

For referring doctors: when to refer an adrenal mass

Early referral helps most when the mass makes hormone, looks suspicious, or may need surgery. You do not need to finish every test first. Please call if you are unsure.

Refer when Helpful to send
A mass that makes too much aldosterone, cortisol or adrenaline-type hormone
Suspected or confirmed pheochromocytoma or paraganglioma
A mass 4 cm or larger, a mass that looks suspicious for cancer on CT or MRI, or one that is growing
Primary aldosteronism with the cause on one side
Masses on both sides with hormone excess
A family history that suggests an inherited syndrome (MEN 2, von Hippel-Lindau, SDH mutations)		 CT or MRI reports, and the images on a disc if possible
Hormone results: metanephrines, aldosterone and renin, dexamethasone suppression cortisol, potassium
Current medicines and blood pressure readings
Family history and any genetic test results
Insurance information

Please do not biopsy an adrenal mass before pheochromocytoma has been ruled out.

How to refer a patient

Call (732) 792-5003 or fax records to (732) 536-0919. Offices: 55 Willow Ln, Suite 101, Englishtown, NJ 07726, and Toms River Shopping Center, 1 Route 37 West, Toms River, NJ 08753. Surgery is at Atlantic Health CentraState Medical Center, 901 West Main Street, Freehold, NJ 07728. Patients can also call the office themselves.

Call the office Request a consultation

Questions

Is an adrenal mass found on CT usually cancer?

No. Most are benign adenomas. Cancer is rare, but a mass still needs a proper work-up, because size, appearance, and hormone testing guide the decision.

Do all adrenal masses need hormone testing?

Most do. A mass can make hormone without causing obvious symptoms, and hormone excess can raise the risks of surgery or harm your heart and bones over time.

Will I need surgery?

Not always. Surgery is advised for masses that make too much hormone from one gland, pheochromocytomas, and masses that look or behave like cancer. Many small benign masses are only followed.

Can adrenal disease cause high blood pressure?

Yes. Primary aldosteronism and pheochromocytoma are two causes of high blood pressure that can be cured or improved with treatment. Ask about testing if your blood pressure is hard to control or your potassium is low.

Do you need steroid pills after surgery?

Only when the removed tumor made cortisol. The other adrenal gland is then suppressed and needs time to recover, so a replacement steroid is given and slowly stopped.

Who should be referred to an adrenal surgeon?

Refer patients whose adrenal mass makes too much hormone, patients with a pheochromocytoma, and patients with a mass that is large, growing or suspicious for cancer. Also refer when primary aldosteronism is traced to one gland.

How do I refer a patient?

Call (732) 792-5003 or fax records to (732) 536-0919. Please include imaging reports and hormone test results if you have them. Patients may also call the office themselves.


Found an adrenal mass or have questions about your results? Call (732) 792-5003 or request a consultation. Office: 55 Willow Ln, Suite 101, Englishtown, NJ. Referring doctors can fax records to (732) 536-0919.

Guidelines

  1. Yip L, et al. Surgery for adrenal tumors: AAES guidelines for adrenalectomy. JAMA Surg 2022;157(10):870-877. doi.org/10.1001/jamasurg.2022.3544
  2. Fassnacht M, et al. ESE/ENSAT guideline on adrenal incidentalomas. Eur J Endocrinol 2023;189(1):G1-G42. doi.org/10.1093/ejendo/lvad066
  3. Adler GK, et al. Primary aldosteronism: Endocrine Society guideline. J Clin Endocrinol Metab 2025;110(9):2453-2495. doi.org/10.1210/clinem/dgaf284
  4. Lenders JWM, et al. Pheochromocytoma and paraganglioma: Endocrine Society guideline. J Clin Endocrinol Metab 2014;99(6):1915-1942. doi.org/10.1210/jc.2014-1498
  5. Nieman LK, et al. Treatment of Cushing's syndrome: Endocrine Society guideline. J Clin Endocrinol Metab 2015;100(8):2807-2831. doi.org/10.1210/jc.2015-1818
  6. Fassnacht M, et al. ESE/ENSAT guideline on adrenocortical carcinoma in adults. Eur J Endocrinol 2018;179(4):G1-G46. doi.org/10.1530/EJE-18-0608
Cover of Atlas of Adrenal Surgery

Atlas of Adrenal Surgery

by Alexander Shifrin, MD (Springer, 2019).

Techniques and outcomes of adrenal surgery, including posterior retroperitoneoscopic and robotic adrenalectomy, with more than 150 color illustrations and videos.

See the book on Amazon →

This page is general information and does not replace a medical evaluation.