Table 1.
Differential diagnosis for adrenal mass—benign masses.
| Type of Benign Mass | Possible Clinical Presentation | References |
|---|---|---|
| Adrenocortical Adenoma (~80%) | [1,2,44] | |
| Non-functional (~75%) | Asymptomatic, discovered on imaging | [1,2,44] |
| Cortisol-Producing (~12%) | Muscle weakness, easy bleeding/bruising, obesity, flushing, CV events, osteoporosis; overt Cushing’s syndrome | [1,2,44] |
| Aldosterone-Producing (~2.5%) | Muscle cramping/weakness, hypertension, headache, fatigue, polydipsia, polyuria, osteoporosis | [1,2,44] |
| Androgen-Producing (~2.5%) | Feminization, virilization (i.e., excessive facial hair, acne, clitoromegaly, male pattern baldness, deepened voice), hirsutism | [1,2,44] |
| Estrogen-Producing (rare) | Men: decreased libido, testicular atrophy, gynecomastiaWomen: IUB 1, breast tenderness | [1,44] |
| Pheochromocytoma (~7%) | Paroxysmal headaches, hypertension, weight loss, sweating, palpitations, anxiety, hot flashes (50%) | [1,2,44] |
| Myelolipoma (rare) | Possible flank/abdominal pain, shock due to rupture/hemorrhage | [44,49] |
| Adrenal Cyst (rare) | Acute abdominal pain | [44,63] |
| Schwannoma (rare) | Compressive symptoms/abdominal discomfort with increased size | [44,64] |
| Ganglioneuroma (rare) | Primarily asymptomatic, even if large | [44,65] |
| Hematoma/Hemorrhage (rare) | Asymptomatic—history of trauma, stress, sepsis, surgery, pregnancySymptomatic—nausea, abdominal pain, fever, hypotension, vomiting | [44,66] |
| Malignancy | ||
| Adrenocortical Carcinoma (~8%) | Compressive symptoms (abdominal and/or flank pain) in 30%, symptoms of GC 2, MC 3, or androgen excess, if functional—40–60% | [1,2,44] |
| Metastatic Cancer (~5%) | Weight loss, vomiting, history of smoking or cancer (primarily lung, then GI, kidney, breast); symptoms of adrenal insufficiency if bilateral (i.e., postural hypotension, hyponatremia, hyperkalemia) | [1,44] |
| Adrenal Lymphoma | Abdominal pain, B symptoms (fever, night sweats, weight loss) | [1,67] |
1 IUB = irregular uterine bleeding, 2 GC = glucocorticoid, 3 MC = mineralocorticoid.