Adrenal gland tests (Assessment of adrenal gland disorders)
A set of blood, urine and sometimes scan-based tests to check whether the adrenal glands are making too much or too little hormone, and whether any lump on a gland needs treatment.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Adrenal tests check whether the glands make too much or too little hormone, and whether a lump needs treatment or monitoring.
- They give information, not treatment: results guide what happens next rather than fixing anything themselves.
- Some tests are timed or done overnight, and several may be needed before a clear picture emerges, so results can take days to weeks.
- Interpretation is specialist work; an endocrinologist should review the results to avoid false reassurance or unnecessary worry.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can show whether the adrenal glands are making too much or too little hormone
Adrenal hormone tests are the wrong tests if symptoms point clearly to another cause, where a different investigation is needed.
Blood and urine tests are quick, though some are timed or done overnight. Scans do not usually hurt but may involve lying still and, sometimes, a contrast...
An endocrinologist who interprets all the results together and explains them.
Blood and urine tests are quick, though some are timed or done overnight. Scans do not usually hurt but may...
You can usually carry on as normal. If a medicine was paused for testing, you will be told when to restart it.
Results are gathered and reviewed by an endocrinologist. You may need a follow-up appointment to discuss what they...
Depending on the results, you may be reassured, offered monitoring with repeat tests or scans, started on...
What is an adrenal gland assessment?
The adrenal glands sit above each kidney and make several important hormones, including cortisol (a stress hormone), aldosterone (which controls salt and blood pressure) and adrenaline-type hormones. An adrenal assessment is a set of tests to check whether these glands are making too much or too little hormone, or whether a lump found on a gland is producing hormone or could be harmful.
Assessment is often triggered by a lump spotted by chance on a scan done for another reason (an 'incidentaloma'), by high blood pressure that is hard to control, or by symptoms suggesting too much or too little hormone. The tests are mostly blood and urine tests, sometimes with specific timed tests and scans.
The aim is to sort people into those who need treatment, those who need monitoring, and those who can be reassured. It is an information-gathering process: it can show whether a gland is over- or under-active, but it does not by itself treat any problem.
This guide explains what the tests involve, what they can and cannot show, and how the results are used. It is general information and not a substitute for advice from an endocrinologist.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Cortisol (Cushing's) tests
Checks for too much cortisol, for example an overnight dexamethasone suppression test (a tablet at night, blood test in the morning) or a late-night salivary cortisol sample.
Aldosterone and renin (Conn's) tests
Blood tests measuring aldosterone and renin, usually in people with high blood pressure, to look for a hormone cause. These are typically done in a hospital setting.
Adrenaline-type (phaeochromocytoma) tests
Blood or urine tests for metanephrines, breakdown products of adrenaline-type hormones, in people with episodes of high blood pressure, palpitations, sweating or headaches.
Adrenal underactivity tests
Tests such as a morning cortisol and a short Synacthen test, used when too little hormone (adrenal insufficiency) is suspected.
Preparing for your test
- Ask why each test is being done and what it is looking for.
- Bring a full list of your medicines and supplements, as several can affect adrenal hormone results.
- Check whether any medicines need pausing or adjusting before testing, as some blood pressure tablets affect aldosterone and renin results.
- Follow timing instructions carefully: some tests need a tablet the night before, an early-morning sample, or a specific posture or rest period.
- Tell the team if you might be pregnant, are very stressed or unwell, or work shifts, as these can affect results.
- Ask whether you need to avoid caffeine, certain foods or strenuous exercise before specific tests.
- Keep any previous results or scan reports to hand.
What happens
Most of the assessment is done through blood and urine tests, sometimes with timed or overnight steps. For a dexamethasone suppression test, you take a tablet at night and have a blood test the next morning. For aldosterone and renin, blood is usually taken under specific conditions in hospital, and some medicines may need adjusting first.
If a lump has been found, a CT or MRI scan looks at its size and features. The results from blood, urine and imaging are then put together by an endocrinologist, because no single test gives the whole answer.
Depending on the findings, you may be reassured, offered monitoring with repeat tests or scans, started on treatment, or referred for surgery if a gland is overactive or a lump is concerning. The team should explain what each result means for you.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Adrenal hormone tests are the wrong tests if symptoms point clearly to another cause, where a different investigation is needed.
- Testing during acute severe illness or major stress can give misleading results and may be better delayed.
- Interpreting results without an endocrinologist risks false reassurance or unnecessary treatment.
- A scan alone cannot confirm whether a lump is hormone-producing; blood and urine tests are also needed.
Delay or rearrange if…
- You are acutely unwell, highly stressed or have a current infection, which can distort results.
- You are on medicines that affect the specific test and these have not yet been reviewed or adjusted.
- You may be pregnant, until the team confirms which tests are appropriate.
- Key preparation, such as correct timing or posture, cannot be followed on the day.
Alternatives to discuss
- No testing, with reassurance, where a lump is small, clearly harmless and not hormone-producing.
- Monitoring with repeat tests or scans rather than immediate further investigation.
- Investigating other causes first if symptoms suggest a different problem.
- Referral to a different specialty if the likely cause lies elsewhere.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can show whether the adrenal glands are making too much or too little hormone
- Helps find a treatable cause of high blood pressure in selected people
- Helps decide whether a lump on a gland needs treatment, monitoring or no action
- Can pick up conditions that are otherwise easy to miss, such as a hormone-producing tumour
- Guides safe, targeted treatment rather than guesswork
Risks & complications
- Discomfort or bruising from blood tests
- The inconvenience of timed, overnight or repeat samples
- Needing more than one test, or repeat testing, before a clear answer
- Temporary medicine changes before some tests
- A borderline or unclear result that needs further tests
- A 'false positive' or 'false negative' result, as no test is perfect
- Incidental findings on a scan that lead to more investigations
- Anxiety while waiting for results or during monitoring
- A reaction to scan contrast dye, if used
- Missing a problem if testing is incomplete or done at the wrong time
- Unnecessary worry or treatment if results are misinterpreted without specialist input
The main pitfalls are testing at the wrong time, on the wrong medicines, or interpreting results without specialist input, all of which can give misleading answers. Adrenal results are easily affected by stress, illness, posture and many common medicines. Ask which medicines to pause, how to prepare for each test, and who will interpret the whole picture.
Published figures to discuss
Adrenal tests vary in accuracy, and results are strongly affected by timing, posture, stress, illness and medicines. False positives and false negatives can occur, which is why specialists often combine tests and repeat borderline results. Reliable single numbers for accuracy do not apply across all settings, so we have kept this qualitative.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Incidental adrenal nodule | Common enough to require a structured pathway | The key questions are whether it makes hormone and whether imaging features suggest cancer. | Guide sourcesClinical context |
| False-positive hormone result | Recognised | Stress, acute illness, medicines, sleep pattern, oestrogen therapy and collection errors can distort cortisol, renin/aldosterone and catecholamine tests. | Guide sourcesClinical context |
| Missing a phaeochromocytoma before biopsy or surgery | Rare but dangerous | Unexplained episodic headache, sweating, palpitations or resistant hypertension should prompt biochemical exclusion before invasive procedures. | Guide sourcesClinical context |
| Need for repeat or dynamic testing | Common in borderline cases | A single adrenal blood test rarely answers the whole question; timing, posture and medication preparation matter. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
These are tests, so there is usually no physical recovery. What matters afterwards is gathering the results, interpreting them together, and agreeing the next step, which can take from a few days to a few weeks.
- No physical recovery needed after most tests
- Mild bruising at blood test sites
- Waiting a little while for all results to come together
- Possibly being asked to repeat a test if timing or medicines affected it
- Restarting any paused medicines as advised
Aftercare
- Restart any paused medicines exactly as instructed.
- Make a note of which tests you have had and when, in case results need comparing later.
- Attend the follow-up appointment to discuss results, as single results out of context can mislead.
- Ask for your results in writing and what they mean for you.
- If monitoring is advised, diarise the repeat tests or scans.
- Keep a record of your blood pressure if that is part of why you are being tested.
- Ask who to contact if you develop new symptoms while waiting.
- A list of the tests done and their dates
- Instructions on restarting any paused medicines
- A booked appointment to discuss results
- A copy of your results and what they mean
- Dates for any repeat tests or scans if monitoring is advised
- A blood pressure record if relevant
- Who to contact about new or worsening symptoms
⚠ Get urgent help if…
- Episodes of severe headache, pounding heartbeat, sweating and very high blood pressure — seek prompt medical advice.
- Severe weakness, dizziness, vomiting or collapse, especially if adrenal underactivity is suspected.
- Very high blood pressure with chest pain, breathlessness or visual disturbance — seek urgent help.
- Muscle weakness, cramps or an irregular heartbeat (possible salt imbalance).
- A reaction after contrast dye, such as a rash, swelling or breathing difficulty.
- Feeling increasingly unwell while waiting for results.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A clear result can show that the adrenal glands are working normally, that a lump is likely harmless, or that there is too much or too little of a particular hormone needing treatment or monitoring. Because adrenal hormones change with stress, time of day, posture and medicines, results must be interpreted carefully and often together rather than one at a time.
A normal result is reassuring but does not always rule out every problem, and a borderline result may need repeating. The most useful outcome is a clear plan: reassurance, monitoring, treatment or referral, with the reasoning explained.
How long results stay useful depends on the situation. A reassuring set of tests for a small, non-active lump may simply lead to a period of monitoring with repeat tests or scans, after which you may be discharged. If a hormone problem is found and treated, ongoing checks are usually needed. Results can change over time, so they are a snapshot rather than a permanent verdict.
Related tests, treatments or support
Adrenal assessment often brings together several tests, because more than one hormone may need checking and imaging adds to the blood and urine results. In people with high blood pressure, adrenal tests may sit alongside other investigations for the cause. Where a lump is found, imaging and hormone tests are usually done together so the picture is complete.
Follow-up & long-term care
Follow-up depends on the findings. You may be discharged with reassurance, offered repeat tests or scans to monitor a lump or borderline result, started on treatment, or referred to a surgeon. An endocrinologist usually coordinates this and should explain the plan, the timing of any repeat tests, and what would prompt further action.
- Repeat blood, urine or imaging tests if monitoring of a lump or hormone level is advised
- Ongoing blood pressure monitoring where relevant
- Review of medicines that can affect adrenal hormone results
- A clear plan for when monitoring can stop or when to re-test
Repeat, follow-on and what comes next
- Borderline or unclear results are common and often need repeating under more controlled conditions.
- More than one test may be combined before a firm conclusion is reached.
- A lump may need repeat scans over time rather than a single assessment.
- Results are a snapshot and may need re-checking if symptoms change.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- An endocrinologist who interprets all the results together and explains them.
- A clear written plan: reassurance, monitoring, treatment or referral.
- Defined timing for any repeat tests or scans.
- Advice on restarting any paused medicines.
- A named contact and guidance on what symptoms should prompt earlier review.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- How many tests are needed and whether any are timed or repeated
- Blood and urine tests and who reports them
- Imaging such as CT or MRI, including any contrast and the reporting fee
- Specialist (endocrinologist) appointments to plan and interpret tests
- Whether monitoring with repeat tests or scans is advised
- Any onward referral, for example to a surgeon
- The specialist fee and how many appointments are included
- The cost of each blood, urine and imaging test and who reports them
- Whether interpretation by an endocrinologist is included
- What happens, and what it costs, if results are borderline and need repeating
- The plan and cost for any monitoring with repeat tests or scans
- Whether an onward referral or surgery would be NHS or private
- How new or urgent symptoms while waiting would be handled
On the NHS? Adrenal testing is available on the NHS when there is a clinical reason, such as a lump found on a scan or hard-to-control blood pressure; private testing is sometimes used for speed or choice, but results should be reviewed by an endocrinologist.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told that common medicines and stress can affect the results.
- Acting on a single test rather than the whole picture.
- No clear plan for who interprets the results and when you will hear.
- Treating a normal result as ruling out every possible problem.
- Not explaining that incidental scan findings may lead to more tests.
Marketing red flags
- Offering a panel of adrenal 'hormone tests' direct to consumers without specialist interpretation.
- Claims that a single test can definitively diagnose or exclude adrenal disease.
- Promoting 'adrenal fatigue' testing, which is not a recognised medical diagnosis.
- Pushing repeat scans or tests without a clear clinical reason.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What exactly are these tests looking for in my case?
- Do I need to stop or adjust any medicines before testing, and when can I restart them?
- How should I prepare for the timing of each test?
- What will the results change about my treatment or monitoring?
- What happens if a result is normal, abnormal or borderline?
- Who will interpret all the results together, and when will I hear?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Why am I being tested when I feel well?
Do I need to stop my medicines before the tests?
Why are some tests done at night or early in the morning?
What happens if a lump is found on my adrenal gland?
Can these tests be done privately?
What if my results are borderline?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Investigation and assessment of adrenal incidentalomas — PMC Investigation and follow-up of incidental adrenal mass — NHS (Right Decisions) Adrenal diagnostics focused on hyperaldosteronism — PMC Evaluation and management of adrenal incidentalomas — PMC Society for Endocrinology — clinical guidance
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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