Adrenal tumours

Adrenal tumours have various patterns of presentation depending on their endocrine functionality and oncological potential. Evaluation of the patient with an adrenal tumour requires a thorough understanding of adrenal physiology and proper application of imaging and biochemical testing to guide therapy. The spectrum of adrenal disease is wide and includes endocrinopathies such as Cushing syndrome, Conn syndrome (hyperaldosteronism) and phaeochromocytoma. Although rare, primary adrenal malignancy dictates a different therapeutic approach from that for benign disease. Non-functional disease includes benign ‘incidentalomas’, malignant masses, both of primary adrenal origin and of metastatic origin, from another primary site. We describe the presentation and natural history of common adrenal pathologies, including the diagnostic work-up and treatment options. Furthermore, operative strategy is discussed with details regarding perioperative issues specific to each pathological entity being treated. A summary of ongoing research in adrenal tumours and controversies in the field is included.