Overview

An adrenal gland tumor is a growth that develops in one or both of the adrenal glands, which are small glands located on top of each kidney. These glands produce essential hormones that regulate metabolism, blood pressure, immune system response, and stress reactions. Adrenal tumors can be benign (non-cancerous) or malignant (cancerous). Many adrenal tumors are non-functioning and do not produce excess hormones, while others, known as functioning tumors, can cause significant hormonal imbalances. Early detection is important because some adrenal tumors may lead to serious health complications if left untreated.

Causes

The exact cause of adrenal gland tumors is not always clear, but several risk factors and conditions are associated with their development:

• Genetic Syndromes: Inherited conditions such as Multiple Endocrine Neoplasia (MEN1), Li-Fraumeni syndrome, and Von Hippel-Lindau disease can increase the risk of adrenal tumors.
• Sporadic Tumors: Many adrenal tumors develop without a known genetic cause or family history.
• Hormonal Dysregulation: Abnormal regulation of hormone production may contribute to the formation of functioning tumors.
• Age Factor: Adrenal tumors are more common in middle-aged and older adults but can occur at any age.
• Gender: Some adrenal tumors, like adrenal cortical carcinoma, may occur slightly more frequently in females.

Symptoms

Symptoms of adrenal tumors vary based on whether the tumor is functioning (producing excess hormones) or non-functioning (silent). Many non-functioning tumors cause no symptoms and are found incidentally during imaging for other reasons.

Common Symptoms of Functioning Adrenal Tumors:

• High Blood Pressure: Especially associated with pheochromocytomas and cortisol-producing tumors.
• Unexplained Weight Gain: Particularly with cortisol-producing tumors (Cushing's syndrome).
• Muscle Weakness: Due to hormonal imbalances.
• Excessive Hair Growth: Hirsutism in women may result from androgen-producing tumors.
• Frequent Headaches and Sweating: Often seen in pheochromocytoma cases.
• Palpitations and Anxiety: Due to excess adrenaline or noradrenaline.
• Changes in Menstrual Cycle: Irregular or absent periods in women.
• Low Potassium Levels: Associated with aldosterone-producing tumors (Conn's syndrome).

Non-Functioning Tumor Symptoms:

• Often asymptomatic.
• Large tumors may cause abdominal pain or a palpable mass.

Diagnosis

Diagnosing an adrenal gland tumor involves a combination of blood tests, imaging studies, and sometimes biopsy.

• Hormonal Blood and Urine Tests: To determine if the tumor is producing excess hormones (cortisol, aldosterone, catecholamines).
• CT Scan or MRI: Imaging tests are used to visualize the adrenal glands and determine the size and characteristics of the tumor.
• Adrenal Vein Sampling: In certain cases, this procedure helps determine hormone production from each adrenal gland.
• PET Scan: May be used to identify malignant tumors or metastases.
• Biopsy: Rarely performed due to the risk of spreading cancer cells, usually reserved for cases where metastatic disease is suspected.

Treatment

Treatment depends on the type of tumor, whether it is benign or malignant, and if it is producing hormones.

• Observation: Small, non-functioning, benign-looking tumors (<4 cm) may be monitored with periodic imaging.
• Surgery (Adrenalectomy): Recommended for functioning tumors, large tumors, or tumors with suspicious features. Minimally invasive laparoscopic surgery is common for benign tumors.
• Medications: Used to manage hormonal effects before or after surgery, especially in cases of pheochromocytoma (alpha and beta-blockers) or aldosterone-producing tumors.
• Chemotherapy and Radiation: Primarily used in adrenal cortical carcinoma or metastatic disease.
• Hormone Replacement: After adrenal gland removal, especially if both glands are affected, hormone replacement therapy may be necessary.

Prognosis

The prognosis for adrenal gland tumors depends on several factors:

• Benign Tumors: Most adrenal tumors are benign, especially adrenal adenomas, with an excellent prognosis following treatment or monitoring.
• Functioning Tumors: Prognosis is favorable when detected early and treated surgically, with many patients experiencing symptom relief.
• Adrenal Cancer: Adrenal cortical carcinoma is rare but aggressive, with variable outcomes. Early detection and complete surgical removal improve survival rates.
• Post-Surgery Outlook: Most patients recover well after surgery, especially with proper hormonal management.
• Follow-up: Lifelong monitoring may be required, particularly for functioning tumors or cases with a genetic predisposition.

Overall, with timely diagnosis and appropriate treatment, many individuals with adrenal gland tumors can lead healthy, normal lives.