What are adrenal tumors?
Adrenal tumors are tumors on the adrenal glands. The adrenal glands are located above the kidneys and have two parts, the adrenal cortex and the adrenal medulla. The adrenal cortex secretes hormones including cortisol and aldosterone. The adrenal medulla produces dopamine, epinephrine and norepinephrine. There are different types of adrenal tumors, and they can be either cancerous or noncancerous (benign).
The vast majority of adrenal tumors are benign. Most often, they do not cause any symptoms and are discovered as incidental findings on either a CT or MRI done for completely unrelated reasons, such as for evaluation of abdominal pain. As such, they are referred to as adrenal incidentalomas. Aside from categorizing them as noncancerous (benign) or cancerous (malignant), they are categorized as functioning or nonfunctioning. Functioning tumors lead to overproduction of one or more of the normal adrenal hormones.
Symptoms and Causes
Are there any risk factors for the development of an adrenal tumor?
The cause of most adrenal tumors is unknown. Some hereditary conditions have been linked to an increased risk of developing an adrenal tumor. The hereditary conditions include:
- Carney complex
- Li-Fraumeni syndrome
- Multiple endocrine neoplasia type 2
- Neurofibromatosis type 1
What are signs and symptoms of adrenal tumors?
Several signs and symptoms may be seen, including:
Diagnosis and Tests
What tests are used to diagnose adrenal tumors?
Blood tests will be completed. A test of the cortisol levels may be done. Urine may need to be collected for 24 hours. A biopsy of the tumor may be completed to determine whether or not the tumor is malignant. Magnetic resonance imaging (MRI) or computed tomography (CT) scans may be used. Other tests may include adrenal vein sampling or a metaiodobenzylguanidine (MIBG) scan. If the tumor is cancerous, the tumor will be staged, which includes the size and location of the tumor; whether it has spread to the lymph nodes; and whether it has spread to other parts of the body.
Management and Treatment
What is the treatment for adrenal tumors?
The tumor may be removed via surgery. It is recommended that most functioning tumors, regardless of their size, be removed. Small, nonfunctioning tumors can be followed with repeat CT scans and if they remain stable in size they can be observed without treatment. If a nonfunctioning tumor grows more rapidly than expected, or if it approaches 5 centimeters in maximum dimension, it is generally removed. If the tumor is small and appears to be noncancerous (benign), a laparoscopic strategy (surgery without large incisions) may be ordered. For a larger tumor or one that may be cancerous, surgery with an incision in the back may be preferred. In some cases, the entire adrenal gland may need to be removed. Hormone therapy may be required prior to or after other options, such as surgery, have been done. If the tumor is cancerous, chemotherapy and radiation therapy may be needed.
What are some of the complications of the treatment of adrenal tumors?
If surgery is done, bleeding may occur. Also, extra stress hormones may be produced by the body. Side effects of chemotherapy include hair loss, risk for infection, fatigue, nausea, vomiting and decreased appetite. Radiation can cause diarrhea, fatigue, nausea and skin reactions.
Can adrenal tumors be prevented?
Adrenal tumors cannot be prevented. The risk factors for this condition are not preventable and are instead often linked to genetics (passed down from your parents).
Outlook / Prognosis
What is the long-term prognosis after treatment for adrenal tumors?
Long-term prognosis may depend on whether or not the tumors are cancerous. If cancerous, the staging of the tumors may determine the prognosis.
What problems are caused by adrenal tumors?
Adrenal tumors can cause several problems. These problems can include:
- Cushing’s Syndrome: This condition occurs when the tumor leads to excessive secretion of cortisol. While most cases of Cushing’s Syndrome are caused by tumors in the pituitary gland in the brain, some happen because of adrenal tumors. Symptoms of this disorder include diabetes, high blood pressure, obesity and sexual dysfunction.
- Conn’s Disease: This condition involves excessive secretion of aldosterone. Symptoms include personality changes, excessive urination, high blood pressure, constipation and weakness.
- Pheochromocytoma: This condition causes excessive secretion of adrenaline and noradrenaline. Symptoms include sweating, high blood pressure, headache, anxiety, weakness and weight loss.