Adrenal Disorders · Naas, Co. Kildare

Adrenal Disorders & Adrenal Incidentaloma

Specialist evaluation of adrenal gland conditions, including incidentally discovered adrenal tumours, Cushing's syndrome, Conn's syndrome, and adrenal insufficiency.

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About the Adrenal Glands

The Adrenal Glands

The adrenal glands are two small triangular glands that sit on top of each kidney. Despite their small size, they produce hormones that are critical to life — cortisol (the body's main stress hormone, involved in metabolism, blood pressure, and immunity), aldosterone (which regulates blood pressure and electrolyte balance), and androgens (male sex hormones, produced in both men and women).

The adrenal gland has two main parts: the cortex (outer layer) which produces cortisol, aldosterone, and androgens; and the medulla (inner part) which produces adrenaline (epinephrine) and noradrenaline. Disorders can affect either part, and can result in hormone excess, hormone deficiency, or structural abnormalities requiring evaluation.

This page is for educational purposes only. It does not constitute medical advice. Always consult a qualified healthcare professional for assessment of adrenal conditions.
Adrenal Conditions

Conditions We Assess

  • Adrenal incidentaloma
  • Cushing's syndrome
  • Conn's syndrome (primary hyperaldosteronism)
  • Phaeochromocytoma (awareness)
  • Adrenal insufficiency
  • Congenital adrenal hyperplasia
  • Adrenal androgen excess
  • Adrenal metastases assessment

Many adrenal conditions require collaboration with endocrine surgery, radiology, and oncology. We coordinate specialist input to ensure comprehensive care.

Specialist Services

How We Can Help

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Adrenal Incidentaloma

Structured evaluation of incidentally found adrenal lesions, including functional assessment for cortisol excess, aldosterone excess, and phaeochromocytoma screening, with guidance on imaging surveillance and surgical referral criteria.

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Cushing's Syndrome

Evaluation of hypercortisolism including overnight dexamethasone suppression testing, 24-hour urinary cortisol, salivary cortisol, and detailed investigation to distinguish adrenal, pituitary, and ectopic ACTH causes.

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Conn's Syndrome

Assessment of primary hyperaldosteronism presenting with hypertension (often resistant to treatment) and hypokalaemia. Aldosterone-renin ratio measurement, adrenal CT, and adrenal vein sampling referral where indicated.

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Adrenal Insufficiency

Diagnosis and management of cortisol deficiency, including primary Addison's disease and secondary (pituitary-related) adrenal insufficiency. Hydrocortisone replacement, sick day rules, and emergency management education.

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Phaeochromocytoma Awareness

Appropriate biochemical screening (plasma or urinary metanephrines) and imaging assessment where phaeochromocytoma is clinically suspected or suggested by adrenal imaging, with urgent referral where indicated.

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Pre- and Post-Surgical Care

Endocrine preparation and follow-up for patients undergoing adrenalectomy, including peri-operative steroid cover, post-operative cortisol recovery assessment, and long-term surveillance.

The Consultation

Adrenal Investigation

Adrenal investigation typically begins with a combination of blood and urine tests. Cortisol assessment includes an overnight low-dose dexamethasone suppression test and/or 24-hour urinary free cortisol. Aldosterone and renin are measured in patients with hypertension or hypokalaemia. Plasma or urinary metanephrines screen for phaeochromocytoma.

Adrenal CT with dedicated adrenal protocol is the standard imaging modality for adrenal masses — CT attenuation (Hounsfield units) and washout characteristics help differentiate benign adenomas from other lesions. In selected cases, MRI adrenals or functional imaging (FDG-PET, MIBG) may be indicated.

All adrenal consultations are led by Dr Syed Kashif Hussain Kazmi, Consultant Endocrinologist (IMC: 213626), with close collaboration with endocrine surgery and diagnostic radiology services when required.

Patient Questions

Frequently Asked Questions

An adrenal incidentaloma is an adrenal mass discovered unexpectedly during imaging of the abdomen or chest performed for an unrelated reason — such as a CT scan for kidney stones, abdominal pain, or as part of cancer staging. They are found in approximately 1–5% of abdominal CT scans, and their prevalence increases with age. The majority are benign non-functioning adenomas. However, all adrenal incidentalomas require specialist evaluation to assess whether they are hormonally active (causing cortisol, aldosterone, or catecholamine excess) and whether they may represent malignancy. Management decisions — including whether to operate or observe — are guided by lesion size, imaging characteristics, and hormonal function.
Conn's syndrome, also called primary hyperaldosteronism, is a condition in which one or both adrenal glands produce excess aldosterone, causing high blood pressure and often low potassium levels (hypokalaemia). It is the most common cause of secondary hypertension, accounting for up to 5–10% of all hypertension cases and a higher proportion of resistant hypertension. It is significantly underdiagnosed. Key clues include hypertension that is difficult to control, unprovoked hypokalaemia, or hypertension in young patients. Diagnosis involves measuring the aldosterone-to-renin ratio. Depending on whether one or both glands are affected, treatment may be surgical (adrenalectomy) or medical (aldosterone antagonist — spironolactone or eplerenone).
Cushing's syndrome is the general term for the clinical and metabolic effects of prolonged excess cortisol, regardless of cause. The most common cause globally is long-term use of corticosteroid medications (iatrogenic Cushing's syndrome). Endogenous (internally produced) excess cortisol can arise from: a pituitary ACTH-secreting adenoma — this specific subtype is called Cushing's disease; an adrenal adenoma or carcinoma secreting cortisol directly; or ectopic ACTH secretion from a tumour elsewhere in the body (e.g., a small cell lung cancer). Distinguishing the cause is essential because the treatment differs significantly. Clinical features include central obesity, moon face, hypertension, diabetes, muscle weakness, bruising, stretch marks, and osteoporosis.
All adrenal masses discovered incidentally require a structured assessment. First, hormonal function is evaluated: an overnight 1mg dexamethasone suppression test screens for autonomous cortisol secretion; plasma or urinary metanephrines screen for phaeochromocytoma (this must be excluded before any surgical intervention); and aldosterone-renin ratio is measured in patients with hypertension or hypokalaemia. Second, imaging characteristics are assessed: CT Hounsfield units below 10 suggest a lipid-rich benign adenoma; higher density lesions or those larger than 4cm require more careful evaluation and may warrant MRI or PET-CT. A multidisciplinary approach involving endocrinology, radiology, and endocrine surgery guides the management decision.
Adrenal insufficiency occurs when the adrenal glands cannot produce sufficient cortisol. Primary adrenal insufficiency (Addison's disease) is caused by destruction of the adrenal cortex itself — in developed countries, the most common cause is autoimmune Addison's disease. Secondary adrenal insufficiency results from insufficient ACTH from the pituitary — causes include pituitary tumours, surgery, or abrupt withdrawal of prolonged corticosteroid therapy. Symptoms include fatigue, weight loss, low blood pressure, salt craving, darkening of skin (in primary disease), nausea, and dizziness. In an adrenal crisis (acute cortisol deficiency triggered by illness or stress), the condition can be life-threatening. Management involves lifelong hydrocortisone replacement and careful education about sick day rules and emergency injection use.

Specialist Assessment of Adrenal Conditions

Book a private adrenal consultation with Dr Kazmi, Consultant Endocrinologist. Prompt, thorough assessment with structured investigation planning.

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