Pituitary and adrenal disorders

The pituitary, at the base of the brain, controls the thyroid, adrenal glands, growth and reproduction. The adrenal glands, above the kidneys, make cortisol, aldosterone and adrenaline. Problems usually show up in one of two ways: a hormone level that is too high or too low, or a lump found on a scan done for another reason.

Being told about a lump is worrying. Most adrenal and pituitary lumps found by chance are benign, and the assessment is there to find the smaller number that need treatment.

Common reasons for referral

• An adrenal or pituitary lump found by chance on a scan (an "incidentaloma"). Adrenal lumps of this kind are common, and more so with age
• A raised prolactin, with or without irregular periods, nipple discharge or low libido
• Suspected cortisol excess (Cushing's syndrome) or deficiency (adrenal insufficiency), including after long courses of steroid tablets, injections or high-dose inhalers
• High blood pressure that may have a hormonal cause. The Endocrine Society's 2025 guideline suggests testing everyone with high blood pressure for primary aldosteronism, using a blood test for aldosterone and renin that can usually be done without stopping blood pressure tablets first. Testing is particularly worthwhile when blood pressure is hard to control, comes with a low potassium level, or an adrenal lump has been found on a scan
• Episodes of palpitations, sweating and headache, where an adrenaline-producing tumour (phaeochromocytoma) needs ruling out

How an adrenal lump is assessed

Two questions: is it making hormones, and could it be cancerous? Under the 2023 European guideline, a lump that looks typically benign on CT needs no further scanning. Cortisol excess can be looked for in more than one way, for example an overnight dexamethasone suppression test, late-night saliva samples or a 24-hour urine collection, and the test is chosen to suit your situation. Aldosterone may be checked if blood pressure is raised or potassium low, and adrenaline-type hormones if the scan appearance is not typical. Adrenal CT scans are done at a CT department, which may be at another hospital.

When more specialist input is needed

Some conditions need dynamic hormone tests in a day unit, scans not available locally, or surgery. Where that is the case, Dr Spiliotis will discuss referral to an NHS or private pituitary or adrenal centre, and can continue to see you alongside that team where that helps. A lump with features that suggest cancer is referred to a specialist cancer team.