Adrenal
25 cases on adrenal insufficiency replacement therapy, pheochromocytoma and paraganglioma management, Cushing's syndrome and mild autonomous cortisol secretion, and congenital adrenal hyperplasia — choose a case below to open its full multi-voice debate.
A single patient, six years into treated Addison's disease. Her cortisol day curve is normal, so the real question isn't whether she's under-replaced by the usual test, but whether a peak-and-trough dosing schedule is producing a gap that test doesn't catch.
A single patient with well-controlled Addison's disease facing a routine procedure whose real stress category depends on what happens mid-case, not on how it was referred.
A single patient whose renin-guided fludrocortisone titration collides with a second medication that suppresses renin on its own, entirely apart from his adrenal regimen.
A single patient optimally replaced on every marker the team already tracks, whose remaining symptom sits at the exact point where two guidelines from the same professional society diverge.
A single patient in refractory septic shock, whose escalating vasopressor requirement sits at the point where two major trials of adjunctive corticosteroids genuinely disagree.
A single patient whose recent illness was managed correctly, but whose living situation exposes a real, documented gap between being trained to self-inject and being able to when a true crisis hits.
A single patient with a technically curable pituitary tumor whose own hypercortisolism has made the surgery to remove it dangerously risky, forcing the team to decide how long to wait, not just whether to.
A single patient whose curable adrenal adenoma sits behind a real, recent fracture history that makes the cure itself dangerous, testing whether treating the hormone excess first can change that calculation.
A single patient whose incidentally found adrenal adenoma sits at exactly the biochemical threshold two 2024-2025 randomized trials studied, against a real, unsettled question of whether his comorbidities are actually cortisol-driven.
A single patient whose recurrent Cushing's disease has three real medical options, none of which is simply the best choice for everyone — the right one depends on which specific risk and which specific symptom matter most to her.
A single patient with an unusually large, high-secreting pheochromocytoma, whose case sits outside the typical patient either major alpha-blocker trial actually enrolled.
A single patient whose known genetic mutation shapes not just her prognosis but which of three real treatment options actually fits her tumor's specific biology.
A single patient whose adrenal vein sampling confirms exactly the finding surgery cures best, set against his own repeated, informed refusal of that surgery.
A single patient whose incidental, imaging-benign adrenal nodule falls under a near-universal testing recommendation written for a population very different from her own.
A single patient whose entirely negative hormonal workup meets an adrenal mass that doesn't cleanly satisfy the newest guideline's own criteria for stopping imaging follow-up altogether.
A single patient whose glucocorticoid dose has never been reducible without losing androgen control, tested against a genuinely new drug with real trial evidence but limited real-world experience.
A single patient whose own androgen control, unrelated to any fetal CAH risk, drifts upward in pregnancy in a way that tests how much a physiologic-range dose adjustment should be trusted against a fetal-exposure literature built on a different clinical scenario.
A single patient whose steroid taper has stalled exactly at the point a 2024 guideline says to hold, against a newer study suggesting that threshold may be more conservative than the evidence now supports.
A single patient in acute adrenal crisis on combination checkpoint inhibitor therapy, where a single lab abnormality argues against the epidemiologically more likely diagnosis before confirmatory testing returns.
A single patient whose steroid dose sits precisely on the line two published frameworks define oppositely, tested against major joint replacement surgery.
A single patient whose bilateral disease rules out surgery, left choosing among three real mineralocorticoid receptor antagonists after the first-line option became intolerable.
A single patient whose antepartum adrenal management has gone smoothly, now facing labor itself — a real stressor whose duration and course can't be known in advance.
A single patient whose adrenal replacement appears stable only three weeks after the crisis that revealed it, now facing a second hormone deficiency whose treatment carries a real, specific risk to the first.
A single patient whose hypercortisolism is severe and fast-moving enough that treatment cannot wait for the slow process of finding its actual source.
A single patient in the exact population the only randomized trial of adjuvant mitotane ever studied, where the trial's own null result sits against real, ongoing treatment toxicity.