Adrenal glands

Physicians must always be aware of potential adrenal pathology when evaluating and treating a surgical patient. In this way, they are more likely to detect occult adrenal insufficiency, pheochromocytomas, functioning adrenal adenomas, and aldosteronomas at an early stage. However, this requires physicians to have a fundamental understanding of both the normal and abnormal endocrine functions of the adrenal gland and a working knowledge of the surgical approaches appropriate for the treatment of the range of adrenal tumors. They must also know the natural history of diseases that can affect the adrenal gland. In particular, they must have an understanding of the natural history and epidemiology of incidental masses of the adrenal gland, functioning and nonfunctioning adenomas, pheochromocytomas, and adrenal cortical carcinomas. This will help the surgeon to evaluate thoroughly and critically a patient with an incidental adrenal mass and then, once the diagnosis is established, to recommend the most appropriate treatment. The discussion in this chapter focuses on aspects of adrenal physiology and pathophysiology important in the surgical evaluation of the patient with a known or suspected adrenal mass, adrenal hormone excess, or adrenal hormone deficiency.