Hepatic Adenoma

Hepatic adenoma, also called liver adenoma or hepatocellular adenoma, is a rare benign (noncancerous) liver tumor. These lesions are often linked to the use of oral contraceptives (birth control pills). They’re most often found in females.

Most hepatic adenomas don’t cause symptoms. But they carry the risk of rupture, which can cause severe pain and internal bleeding. Rarely, they can become malignant (cancerous). When this happens, it’s called hepatocellular carcinoma. Adenomas can grow in the setting of estrogen, so they may grow during pregnancy and need more frequent monitoring.

Because of these risks, making a proper diagnosis is important. Healthcare providers carefully monitor or treat hepatic adenomas based on their size, type and who they affect.

Types of hepatic adenoma

Healthcare providers group hepatic adenomas into different types based on variations in genes and how the tumor behaves. They may do a biopsy to figure out the type, but not all adenomas require it. Your provider will help you understand when you may need one.

Knowing the type helps your provider guide monitoring and treatment. Types of hepatic adenomas include:

• Inflammatory hepatic adenoma: This is the most common type. It’s often linked to estrogen exposure, obesity and excessive alcohol use. It mainly affects females. These lesions are more likely to cause symptoms and can bleed.
• HNF-1 alpha–mutated hepatic adenoma: This is the second most common type. It mainly affects females who use estrogen-containing birth control. These tumors usually have a lower risk of bleeding or becoming cancerous when they’re small.
• Beta-catenin–mutated hepatic adenoma (exon 3): This type has the highest risk of turning into cancer. It’s more common in males and people who use anabolic steroids. Because of the cancer risk, providers usually treat these lesions with surgery.
• Mixed inflammatory and beta-catenin–mutated hepatic adenoma (exon 3): This tumor shows features of both inflammatory and beta-catenin–mutated adenomas. They’re more common in females. But they carry a higher cancer risk because of the beta-catenin variation.
• Beta-catenin–mutated hepatic adenoma (exon 7 or 8): This type has a much lower cancer risk than exon 3 tumors. But it still has a higher risk of bleeding. They’re found only in females. They’re linked to certain genetic conditions, like glycogen storage disease.
• Mixed inflammatory and beta-catenin–mutated hepatic adenoma (exon 7 or 8): This lesion is mostly inflammatory but also has beta-catenin variations. They’re linked to obesity and alcohol use. They have a higher risk of bleeding.
• Sonic hedgehog hepatic adenoma: This rare type has the highest risk of bleeding. It’s been linked to long-term use of estrogen-containing birth control and fatty liver changes.
• Unclassified hepatic adenoma: About 5% to 10% of hepatic adenomas don’t fit into a specific type. These tumors don’t show clear features. They’re managed based on size, symptoms and risk factors.

Hepatic adenoma symptoms

Most people with hepatic adenoma don’t have symptoms. Healthcare providers usually find them on abdominal imaging done for another reason. If the tumor is large, you may have symptoms like:

• Upper right abdominal pain or discomfort
• Nausea
• A feeling of fullness or pressure in your abdomen

If the tumor ruptures, it can cause serious internal bleeding. That’s a medical emergency. Seek immediate medical care if you develop:

• Sudden, severe abdominal pain
• Symptoms of shock, like dizziness, a fast pulse or shallow breathing
• Symptoms of low blood pressure, like lightheadedness, nausea or blurred vision

Causes of hepatic adenoma

Researchers don’t know the exact cause of hepatic adenoma. But it develops when liver cells begin to grow in an abnormal but noncancerous way. This growth is strongly influenced by hormones, especially estrogen but also testosterone. Changes in how your body handles sugar and fat can also lead to it.

In most cases, hepatic adenoma forms in a healthy liver. People with MASH are also more likely to develop adenomas. Certain hormones and metabolic conditions can signal liver cells to multiply more than they should. This may lead to tumor growth over time.

Risk factors

Hepatic adenoma is most common in females. Estrogen exposure, especially from oral contraceptives (birth control pills) and hormone replacement therapy, increases your risk. The condition also more commonly affects people who:

• Are ages 20 to 40
• Are pregnant
• Use anabolic steroids
• Have certain genetic conditions, like glycogen storage disease
• Have metabolic syndrome, obesity or MASH
• Drink alcohol

How to lower your risk

You may be able to lower your risk by:

• Avoiding or stopping estrogen-containing medications if advised by your healthcare provider
• Maintaining a healthy weight for you
• Managing conditions linked to metabolic syndrome, like diabetes
• Limiting the amount of alcohol you drink

Always talk with your provider before stopping or changing any medications.

Complications of hepatic adenoma

Possible complications of hepatic adenoma include:

• Bleeding: Larger tumors are more likely to bleed. In rare cases, the tumor can rupture and cause life-threatening internal bleeding.
• Cancer risk: Some hepatic adenomas, especially certain subtypes and those in males, have a higher chance of becoming cancerous.

How doctors diagnose hepatic adenoma

Your healthcare provider will use detailed imaging tests to detect signs of hepatic adenoma. They may diagnose the condition if the imaging tests show a solid liver lesion.

Hepatic adenoma radiology tests may include:

• Contrast-enhanced ultrasound (CEUS): CEUS is often the first test to detect an issue with your liver.
• MRI with contrast: This is the most useful test for diagnosing hepatic adenoma and identifying its subtype.
• CT scan: A CT scan helps show the size and structure of the tumor.

Your provider may order a liver biopsy if the imaging results aren’t clear or they can’t determine the subtype.

How is hepatic adenoma treated?

Liver adenoma treatment depends on several factors, including:

• The tumor size
• The subtype
• Your symptoms
• Your sex

If you have a small, low-risk tumor, your healthcare provider may recommend monitoring it. They’ll want you to have regular imaging tests to check for changes. Stopping the use of oral contraceptives or hormone therapy can sometimes cause tumors to shrink or stop growing.

Your provider may recommend treatment for:

• Larger tumors
• Tumors that have a high risk of rupture (in males)
• Tumors that look cancerous

Hepatic adenoma treatment options include:

• Surgical resection: This is the surgical removal of the tumor.
• Transarterial embolization (TAE): This is a procedure that blocks blood flow to the tumor.
• Radiofrequency ablation: This procedure uses heat to destroy the tumor.

Recovery time

Recovery after surgery or procedures like embolization varies, but it may take several weeks. Your healthcare provider will guide you based on your situation.

When should I see my healthcare provider?

Contact your provider if you:

• Have ongoing or worsening abdominal pain
• Notice new symptoms
• Are diagnosed with hepatic adenoma and become pregnant

Seek emergency care if you have sudden, severe abdominal pain, dizziness or signs of low blood pressure.

What can I expect if I have this condition?

Most people with hepatic adenoma do very well, especially when higher-risk tumors are treated. Many tumors stay stable or shrink after hormone changes or weight loss. Your long-term outlook is generally good with proper treatment and follow-up.

Can hepatic adenoma go away on its own?

Hepatic adenoma always requires medical care. Your healthcare provider may recommend monitoring to see if the tumor shrinks or stops growing. If the adenoma doesn’t shrink, you’ll need to follow up with regular imaging.

Can I get pregnant if I have hepatic adenoma?

Many people with small tumors can safely become pregnant. But your healthcare provider will want to closely monitor you throughout your pregnancy.