The Laboratory Diagnosis of Adrenocortical Disease

Almost all disorders of the adrenal gland involve the adrenal cortex. Endogenous Cushing’s syndrome (hypercortisolism) affects 1–2 of every 100,000 people each year (Arlt, Harrison’s principles of internal medicine, 21st edn. McGraw Hill, New York, 2022) while congenital adrenal hyperplasia affects 1 in 15,000 births (Alter, Contemporary practice in clinical chemistry, 4th edn. Academic Press, London, 2020). Addison’s disease (primary hypocortisolism) afflicts 2 of every 10,000 people (Arlt, Harrison’s principles of internal medicine, 21st edn. McGraw Hill, New York, 2022), and Conn’s syndrome (primary aldosteronism) affects 5–12% of all people with hypertension (Arlt, Harrison’s principles of internal medicine, 21st edn. McGraw Hill, New York, 2022). In contrast, pheochromocytoma (the major disorder affecting the adrenal medulla) has an incidence of only 2–5 cases per million people per year (Eisenhofer, Tietz textbook of laboratory medicine, 7th edn. Saunders, St. Louis, 2022). Understanding the diagnostic workup of adrenocortical disease is important.