What is an adrenal tumor? 

Adrenal glands are small glands located above kidneys. They secrete hormones that help your body respond to stress, regulate your blood sugar, blood pressure and immune system by secreting hormones like cortisol, aldosterone, dopamine, epinephrine and norepinephrine. 

Adrenal tumors may be benign (not cancer) or malignant (cancer). Adrenal adenomas are noncancerous growths in adrenal glands. Adrenal adenomas don’t usually cause symptoms or require treatment. Some of them may secrete adrenal hormones and cause symptoms. The most common cancerous tumor that forms in your adrenal glands is adreno-cortical carcinoma. 

What types of adrenal tumors are there? 

Adrenal tumors can be in any of the following combinations: 

1. Adrenal adenoma 

1. Functioning (active) adrenal adenomas secrete excess adrenal gland hormones and may cause symptoms that require treatment. 

2. Nonfunctioning (inactive) adrenal adenomas don’t produce excess adrenal hormones. Most adrenal adenomas are nonfunctioning. They don’t cause symptoms or require treatment. 

2. Adrenal carcinoma 

1. Functioning (active) adrenal carcinoma secrete excess adrenal gland hormones. 

2. Nonfunctioning (inactive) adrenal carcinoma don’t produce excess adrenal hormones. 

What are the effects of adrenal adenoma? 

Functioning adrenal adenomas can cause adrenal glands to secrete excess amounts of one or more types of hormone. This leads to following types of syndromes: 

1. Cushing’s syndrome: 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. 

2. 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. 

3. An adrenal adenoma may secrete excess androgens (for example, testosterone) in people assigned female at birth may lead to irregular periods, increased body hair (hirsutism), a deeper voice, etc. Too much oestrogen in people assigned male at birth (AMAB) may cause decreased sex drive and erectile dysfunction. 

4. Pheochromocytoma: in this condition adrenal produces excess chemicals affecting the sympathetic pathway leading to raised blood pressures, palpitations, headache and sweating.

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). 

● Diabetes 

● Stretch marks on your abdomen. 

● Weight gain, especially in your upper body. 

● Mood changes (feeling anxious, panicked or depressed). 

● Irregular menstrual cycles and increased masculine characteristics (virilization). ● 

What causes adrenal adenomas? 

No dietary or environmental risk factor has been associated with adrenal tumor, however certain genetic conditions may increase risk. 

● Multiple endocrine neoplasia, type 1 (MEN1). 

● Familial adenomatous polyposis (FAP) 

● Carney complex. 

● Li-Fraumeni syndrome 

● Multiple endocrine neoplasia type 2 (MEN2). 

How are adrenal tumors diagnosed? 

Adrenal adenomas are routinely diagnosed during an imaging procedure for an unrelated medical condition thus sometimes called “incidentalomas”. In other cases they are diagnosed upon evaluation of symptoms like refractory hypertension, hirsutism, headaches and palpitations. 

What tests are used to diagnose adrenal adenoma? 

Following set of tests are done to evaluate an adrenal adenoma to know its location, size, number, characteristics including functional status. 

● Blood or urine test:A blood or urine test is used to check for elevated hormone levels that may be a sign of a functioning tumor. 

● Imaging: A CT scan is the most commonly used imaging procedure used to diagnose adrenal adenoma. Imaging also helps 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. 

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

What is the treatment for adrenal adenoma? 

Small nonfunctioning tumors are managed conservatively with periodic CT scans to ensure it doesn’t increase in size or become functional. If the tumor grows rapidly or gets bigger (Greater than 4 cm), removal is recommended. Large tumors and rapid growth increase the likelihood of a tumor becoming cancerous. 

Treatments for functioning tumors almost always involve surgery. 

● Adrenalectomy: Adrenal tumors can be removed via open, laparoscopic or robotic approach. For a larger tumor or one that may be cancerous an open procedure may be preferred. Patient is simultaneously started on medicines that prevent the adenoma from making excessive amounts of hormones. Robotic procedure offers several advantages over conventional surgery including but not limited to less blood loss and less need for blood transfusion, less pain, lower risk of complications/wound complications, shorter hospital stay and fewer days with catheter and faster recovery and return to normal activities 

What is the long-term prognosis for adrenal adenoma? 

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