A Diagnostic Approach to Adrenocortical Tumors

Surg Pathol Clin. 2019 Dec;12(4):967-995. doi: 10.1016/j.path.2019.08.005. Epub 2019 Sep 27.


Adrenocortical tumors range from primary bilateral micronodular or macronodular forms of adrenocortical disease to conventional adrenocortical adenomas and carcinomas. Accurate classification of these neoplasms is critical given the varied pathogenesis, clinical behavior, and outcome of these different lesions. Confirmation of adrenocortical origin, diagnosing malignancy, providing relevant prognostic information in adrenocortical carcinoma, and correlation of laboratory results with clinicopathologic findings are among the important responsibilities of pathologists who evaluate these lesions. This article focuses on a practical approach to the evaluation of adrenocortical tumors with an emphasis on clinical and imaging findings, morphologic characteristics, and multifactorial diagnostic schemes and algorithms.

Keywords: Adrenal cortical adenoma; Adrenal cortical carcinoma; Adrenal gland; Cushing syndrome; IGF-2; Nodular cortical disease; Primary aldosteronism; Virilism and feminization.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Neoplasms / diagnosis*
  • Adrenal Cortex Neoplasms / genetics
  • Adrenal Cortex Neoplasms / pathology
  • Adrenocortical Adenoma / diagnosis*
  • Adrenocortical Adenoma / genetics
  • Adrenocortical Adenoma / pathology
  • Adrenocortical Carcinoma / diagnosis*
  • Adrenocortical Carcinoma / genetics
  • Adrenocortical Carcinoma / pathology
  • Cushing Syndrome / etiology*
  • Cushing Syndrome / pathology
  • Genetic Carrier Screening
  • Guidelines as Topic
  • Humans
  • Immunohistochemistry