Endocrine Disorders and Adrenal Function

The adrenal glands, perched atop the kidneys, orchestrate critical hormonal responses that maintain homeostasis through the secretion of glucocorticoids, mineralocorticoids and adrenal androgens. Dysregulation of adrenal function gives rise to a spectrum of endocrine disorders, ranging from cortisol excess in Cushing’s syndrome to cortisol deficiency in primary adrenal insufficiency (Addison’s disease), as well as autonomous aldosterone production in primary hyperaldosteronism. Incidentally discovered adrenal masses, or incidentalomas, have become increasingly prevalent with the widespread use of cross-sectional imaging, posing diagnostic and management dilemmas. Clinical manifestations of adrenal disorders span metabolic, cardiovascular, neuropsychiatric and musculoskeletal systems, often compounding the risk of morbidity and mortality. Advances in imaging modalities, biochemical assays and molecular profiling have enhanced diagnostic precision, enabling better differentiation between benign and malignant lesions and more accurate assessment of hormone autonomy. Therapeutic strategies encompass surgical resection for hormonally active or suspicious masses, targeted pharmacological blockade of steroidogenesis or receptor activity, and lifelong hormone replacement where necessary. Global health initiatives emphasise early detection, standardised clinical pathways and equitable access to specialist care. Ongoing research seeks to refine risk stratification algorithms, unravel genetic underpinnings of adrenal pathologies and develop personalised interventions that mitigate long-term complications and improve patient quality of life.

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Research from all publishers

Updated European clinical practice guidelines have refined the assessment and management of adrenal incidentalomas by defining size and radiological risk thresholds, standardising the work-up for mild autonomous cortisol secretion and advocating a multidisciplinary approach to distinguish benign non-functioning lesions from those warranting surgery. A multicentre prospective validation of urine steroid metabolomics demonstrated that profiling of urinary steroid signatures significantly improves the specificity of adrenocortical carcinoma diagnosis when combined with tumour size and imaging characteristics, thereby streamlining patient selection for surgical intervention. Advances in medical therapy for Cushing’s disease have emerged from recent clinical trials of novel adrenal steroidogenesis inhibitors, long-acting somatostatin analogues and selective glucocorticoid receptor modulators, offering effective alternatives or adjuncts to surgery for patients with persistent or recurrent hypercortisolism and laying the groundwork for personalised pharmacotherapy in complex cases.

Endocrine Disorders and Adrenal Function publication trend

The graph below shows the total number of articles in endocrine disorders and adrenal function across all publications each year (not limited to Nature Index journals).

Technical terms

Adrenal incidentaloma: An adrenal mass detected unexpectedly on imaging performed for unrelated indications.

Autonomous cortisol secretion: Cortisol production by an adrenal lesion independent of normal regulatory control.

Dexamethasone suppression test: A biochemical assay in which dexamethasone is administered to evaluate the feedback suppression of cortisol secretion.

Hounsfield unit (HU): A quantitative scale for radiodensity used in computed tomography to characterise tissue composition.

Urine steroid metabolomics: The comprehensive profiling of urinary steroid metabolites to distinguish benign from malignant adrenal disease.

11β-hydroxylase inhibitor: A class of drugs that block the enzyme responsible for the final step of cortisol synthesis, used to control hypercortisolism.

References

1. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. European Journal of Endocrinology (2023).
2. Urine steroid metabolomics for the differential diagnosis of adrenal incidentalomas in the EURINE-ACT study: a prospective test validation study. The Lancet Diabetes & Endocrinology (2020).
3. Medical Treatment of Cushing's Disease: An Overview of the Current and Recent Clinical Trials. Frontiers in Endocrinology (2020).