Adrenal Adenoma

What is an adrenal adenoma?

Adrenal adenomas are benign (noncancerous) tumors in your adrenal glands. Your adrenal glands are small, triangular glands located atop both of your kidneys. They secrete hormones that help your body respond to stress. Your adrenal glands also release hormones that regulate your blood sugar, blood pressure and immune system, among other essential functions.

Your adrenal glands have two parts, your adrenal cortex and your adrenal medulla. Your adrenal cortex secretes hormones, including cortisol and aldosterone. The adrenal medulla produces dopamine, epinephrine and norepinephrine. Adrenal adenomas form in your adrenal cortex.

Adrenal adenomas don’t usually cause symptoms or require treatment. Some may lead to the overproduction of one or more normal adrenal hormones.

What types of adrenal adenomas are there?

Adrenal adenomas are either functioning or nonfunctioning.

• Functioning (active) adrenal adenomas secrete excess adrenal gland hormones and may cause symptoms that require treatment.
• Nonfunctioning (inactive) adrenal adenomas don’t produce excess adrenal hormones. Most adrenal adenomas are nonfunctioning. They don’t cause symptoms or require treatment.

Neither type of tumor is likely to become cancer, but a nonfunctional adrenal adenoma can become functional.

Can an adrenal adenoma become cancerous?

Adrenal adenomas can become cancerous, but this is rare. The most common cancerous tumor that forms in your adrenal glands is adrenocortical carcinoma. Like adrenal adenomas, functioning adrenocortical carcinoma tumors secrete excess hormones. They may cause symptoms similar to functioning adrenal adenomas.

Only about 1 in 1 million people develop adrenocortical carcinoma. The majority of adrenal tumors are benign (noncancerous).

Who do adrenal adenomas affect?

Anyone can get an adrenal adenoma, although the likelihood increases with age. Approximately 3% to 9% of people have adrenal adenomas. They’re the most common type of adrenal gland tumor.

How does an adrenal adenoma affect my body?

Functioning adrenal adenomas can cause your adrenal glands to secrete excess amounts of one or more types of hormone. As a result, you may experience symptoms of certain adrenal disorders, including:

• Cushing’s syndrome (hypercortisolism): This condition occurs when your adenoma secretes too much cortisol. Tumors in your pituitary gland most often cause Cushing’s syndrome, but adrenal tumors can also lead to Cushing's syndrome. Symptoms include high blood pressure, weight gain (especially around your middle) and sexual dysfunction. It can increase your likelihood of diabetes.
• Primary aldosteronism (Conn’s syndrome): This condition occurs when your adenoma secretes too much aldosterone. Signs and symptoms include low potassium levels, high blood pressure, headache, fatigue and muscle weakness.
• In rare instances, an adrenal adenoma may secrete excess sex hormones. Too many androgens (for example, testosterone) in people assigned female at birth (AFAB) may lead to irregular periods, increased body hair (hirsutism), a deeper voice, etc. Too much estrogen in people assigned male at birth (AMAB) may cause decreased sex drive and erectile dysfunction.

What are the symptoms of an adrenal adenoma?

Functioning adrenal adenomas may produce symptoms related to having excess hormones in your body, especially excess cortisol (Cushing’s syndrome) or excess aldosterone (Primary aldosteronism).

Signs and symptoms may include:

• Headache.
• Muscle weakness or occasional numbness.
• Fatigue and achiness (like backaches).
• High blood pressure (hypertension).
• High blood sugar levels or diabetes.
• Low potassium levels.
• Stretch marks on your abdomen.
• Weight gain, especially in your upper body.
• Mood changes (feeling anxious, panicked or depressed).

People AFAB may experience irregular menstrual cycles and increased masculine characteristics (virilization). People AMAB may experience sexual dysfunction.

What causes adrenal adenomas?

Researchers don’t know what causes an adrenal adenoma or other benign adrenal gland tumors to form. Still, certain genetic conditions may increase your risk, including:

• Multiple endocrine neoplasia, type 1 (MEN1).
• Familial adenomatous polyposis (FAP).
• Carney complex.
• Li-Fraumeni syndrome.
• Multiple endocrine neoplasia type 2 (MEN2).
• Neurofibromatosis Type 1.

Obesity and tobacco use may also increase your chances of having an adrenal adenoma.

How are adrenal tumors diagnosed?

Many people don’t realize they have an adrenal adenoma until their healthcare provider discovers an adrenal gland tumor during an imaging procedure for an unrelated medical condition. These tumors are sometimes called “incidentalomas” because they’re found incidentally, or by chance.

Your healthcare provider will first determine whether a tumor is cancerous (for example, adrenocortical carcinoma) or benign (for example, adrenal adenoma). If it’s an adrenal adenoma, they’ll perform tests to determine whether it’s secreting excess hormones.

What tests are used to diagnose adrenal adenoma?

Your healthcare provider will perform a physical exam and ask you about your symptoms and medical history. They may perform any of the following tests to learn more about your tumor:

• Blood or urine test: A blood or urine test allows your healthcare provider to check for elevated hormone levels that may be a sign of a functioning tumor. You may need to collect your urine for 24 hours so they can test it for elevated cortisol.
• Imaging: A CT scan is the most commonly used imaging procedure used to diagnose adrenal adenoma. In some instances, your healthcare provider may order an MRI instead. Imaging helps them determine whether a tumor is malignant or benign. For example, larger tumors (more than 4 centimeters) are more likely to be cancerous than smaller tumors.
• Biopsy: Your healthcare provider may perform a fine-needle aspiration if other tests don’t provide enough information about whether a tumor is cancer or an adrenal adenoma. During this procedure, they’ll use a thin hollow needle to remove tissue from the tumor. A lab specialist, called a pathologist, examines the tissue underneath a microscope to check for signs of cancer.

Other tests may include adrenal vein sampling or a metaiodobenzylguanidine (MIBG) scan.

What is the treatment for adrenal adenoma?

Your treatment depends on whether the tumor is nonfunctioning or functioning (secreting excess hormones). If a nonfunctioning tumor is small, your healthcare provider may recommend periodic CT scans to ensure it doesn’t increase in size or become functional. If the tumor grows rapidly or gets bigger (usually nearing 5 centimeters), your healthcare provider may recommend surgery. Large tumors and rapid growth increase the likelihood of a tumor becoming cancerous.

Treatments for functioning tumors almost always involve surgery. Treatments include:

• Adrenalectomy (adrenal gland removal): Your healthcare provider may remove your adrenal gland via laparoscopy if the tumor is benign and small. During a laparoscopy, they make tiny cuts into your abdomen and perform the surgery through the incisions. For a larger tumor or one that may be cancerous, your healthcare provider may perform surgery by making a larger incision in your back. In some instances, your remaining adrenal gland may make enough hormones to keep you healthy. In others, you may need hormone therapy to supplement the lack of hormones.
• Medications: If you’re not a candidate for surgery, your healthcare provider may prescribe medicines that prevent the adenoma from making excessive amounts of hormones. You may also receive medications for several weeks to help stabilize your hormone levels following an adrenalectomy.

Can adrenal gland tumors be prevented?

Adrenal gland tumors, including adrenal adenoma, can’t be prevented. The risk factors for adrenal adenoma often depend on your genes. Still, you can develop an adrenal adenoma even if no one in your family has a history of adrenal gland tumors.

What is the long-term prognosis after treatment for adrenal adenoma?

Treatment outcomes associated with adrenalectomy are excellent. Removing the affected adrenal gland often relieves the symptoms related to functional adrenal adenomas.

How do I take care of myself?

Follow your healthcare provider’s guidance about how often you should be tested if you’ve been diagnosed with a nonfunctioning adrenal adenoma. Depending on your tumor, your healthcare provider may recommend periodic CT scans or hormone testing.

What questions should I ask my doctor?

• What type of adrenal gland tumor do I have?
• Is it benign or cancerous?
• What is the likelihood that my tumor could become cancerous?
• Is it a functioning or nonfunctioning tumor?
• Do I need treatment?
• What treatments would you recommend?
• Will I need hormone therapy as part of my treatment/recovery?

A note from Cleveland Clinic

Don’t be too alarmed if your healthcare provider finds an adrenal gland tumor during an imaging procedure. Most often, these tumors are harmless. If your tumor turns out to be an adrenal adenoma, your healthcare provider can run tests to see if it’s causing an overproduction of hormones. If it is, surgery can help. If your tumor is nonfunctioning, your healthcare provider can monitor it to ensure it doesn’t negatively impact your hormones. If there’s a concern that it could become malignant, your healthcare provider can remove it.