Adrenal gland tumors

Most adrenal gland tumors are unilateral. These tumors can be functional ( hormone producing ) or silent. They can further be divided as benign or malignant.

  •  A vast majority of adrenocortical tumors are benign, nonfunctioning adenomas that are discovered incidentally on CT scans or MRI done for unrelated reasons. These are called Incidentalomas.
  • Some adrenal tumors are benign, hormone-secreting adenomas that cause Cushing's syndrome, primary aldosteronism, or much less commonly, virilization.
  • Adrenocortical carcinomas (ACCs) are very rare however they are very aggressive  and often times diagnosed  with widespread metastasis making them unresectable.
  • Pheochromocytomas are catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla. They may be benign or malignant. 

Most of the times, adrenal tumors are asymptomatic. However  hormone producing adrenal tumors  can produce variety of symptoms like  :

  • High blood pressure (hypertension)
  • Women: Excess facial and body hair, deep voice or problems with menstruation
  • Men: breast tenderness or enlargement, lowered sex drive and/or erectile dysfunction
  • Excess fat in the upper back between the shoulders or in the neck
  • Round, full face shape, also called “moon” face
  • Thin skin that bruises easily and heals slowly
  • Purple-red stretch marks on the belly, thighs or breasts
  • Fatigue
  • Muscle weakness or spasms
  • Weight gain or loss
  • Diabetes
  • Insomnia or other sleep disorders
  • Low potassium levels
  • Headche      
  • Rapid or irregular heartbeats
  • Feelings of anxiety, panic, fear
  • Pallor (paleness)
  • Dizziness/lightheadedness with standing
  • Tremor
  • Sweating
  • Temporary/intermittent paralysis (rare)

Several blood test are ordered to  identify any functional hormone production by the Adrenal tumors.

These may include fasting blood glucose, serum potassium, cortisol, corticotropin (ACTH), 24-hour urinary free cortisol, fasting serum cortisol at 8 AM following a 1 mg dose of dexamethasone at bedtime, adrenal androgens (dehydroepiandrosterone-sulfate [DHEA-S], androstenedione, testosterone, 17-OH progesterone), and serum estradiol in men and postmenopausal women .

Radiologic imaging studies like computed tomography (CT) scanning can usually distinguish adenomas from Adrenocortical carcinomas. Positron emission tomography (PET) scanning with fluorodeoxyglucose (FDG) is of value for distinguishing Adrenal Adenoma from Adrenocortical Carcinoma. The most common sites of distant spread for ACC are the liver, lungs, lymph nodes, and bone.  If ACC  is suspected, CT imaging  of the chest and liver as well as bone scan are typically included in the staging workup.

Fine-needle aspiration biopsy — Cytology from a adrenal biopsy cannot distinguish a benign adrenal mass from adrenal carcinoma. However,  FNA can distinguish between an adrenal tumor and a metastatic tumor from other parts of the body.

There are no known lifestyle changes to lower the risk of developing adrenal gland tumors. However reducing obesity, smoking, alcohol will help you in reducing the chances of developing cancers in general.

Certain genetic  disorders can increase your risk of having an adrenal disease. These  syndromes include:

  • Von Hippel-Lindau Syndrome (VHL)
  • Beckwith-Wiedemann syndrome
  • Li-Fraumeni syndrome (pdf)
  • Multiple Endocrine Neoplasia type 2 (MEN2)
  • Neurofibromatosis type 1, also known as von Recklinghausen’s disease
  • Paraganglioma syndrome

 If you have any family member diagnosed with any of the above syndromes,  your doctor may order genetic  testing.

We offer a depth of cancer resources for our patients and their caregivers.  You may find educational documents, cancer information  on adrenal tumors at  links listed below :

The following organizations also provide reliable health information.

  • National Library of Medicine

    (www.nlm.nih.gov/medlineplus/healthtopics.html)

  • Hormone Health Network

    (www.hormone.org available in English and Spanish)

  • National Institute of Diabetes and Digestive and Kidney Diseases

    (http://endocrine.niddk.nih.gov/index.htm)

  • National Adrenal Diseases Foundation

    (516) 487-4992

    (www.nadf.us)

  • Pituitary Tumor Network Association

    (www.pituitary.org)

  • Cushing's Support & Research Foundation

    (617) 723-3674

    (http://csrf.net/)

 

Because  we are  experts  in Cancer care for more patients with adrenal gland tumor than most other programs in  West Coast of Florida, we have a higher level of experience that can have a direct impact on your chance for successful cure.

We have expertise in both minimally invasive ( Laparoscopic and Robotic ) approach to removal of benign or functional Adrenal tumors.  If you are diagnosed with Malignant Adrenal tumors, minimally invasive approach is not recommended as it has higher rates of recurrence.

On your consultation, we will discuss the details of  all the possible approaches to successfully removal of the adrenal tumor. We will also discuss the risk, benefits and postoperative recovery in details.  You may need  post operative chemotherapy , hormone replacement  after removal of the adrenal gland. We will work in close association with your oncologist and primary care physician to make sure that you get the recommended postoperative care.

Basics

Most adrenal gland tumors are unilateral. These tumors can be functional ( hormone producing ) or silent. They can further be divided as benign or malignant.

  •  A vast majority of adrenocortical tumors are benign, nonfunctioning adenomas that are discovered incidentally on CT scans or MRI done for unrelated reasons. These are called Incidentalomas.
  • Some adrenal tumors are benign, hormone-secreting adenomas that cause Cushing's syndrome, primary aldosteronism, or much less commonly, virilization.
  • Adrenocortical carcinomas (ACCs) are very rare however they are very aggressive  and often times diagnosed  with widespread metastasis making them unresectable.
  • Pheochromocytomas are catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla. They may be benign or malignant. 

Symptoms

Most of the times, adrenal tumors are asymptomatic. However  hormone producing adrenal tumors  can produce variety of symptoms like  :

  • High blood pressure (hypertension)
  • Women: Excess facial and body hair, deep voice or problems with menstruation
  • Men: breast tenderness or enlargement, lowered sex drive and/or erectile dysfunction
  • Excess fat in the upper back between the shoulders or in the neck
  • Round, full face shape, also called “moon” face
  • Thin skin that bruises easily and heals slowly
  • Purple-red stretch marks on the belly, thighs or breasts
  • Fatigue
  • Muscle weakness or spasms
  • Weight gain or loss
  • Diabetes
  • Insomnia or other sleep disorders
  • Low potassium levels
  • Headche      
  • Rapid or irregular heartbeats
  • Feelings of anxiety, panic, fear
  • Pallor (paleness)
  • Dizziness/lightheadedness with standing
  • Tremor
  • Sweating
  • Temporary/intermittent paralysis (rare)

Diagnosis

Several blood test are ordered to  identify any functional hormone production by the Adrenal tumors.

These may include fasting blood glucose, serum potassium, cortisol, corticotropin (ACTH), 24-hour urinary free cortisol, fasting serum cortisol at 8 AM following a 1 mg dose of dexamethasone at bedtime, adrenal androgens (dehydroepiandrosterone-sulfate [DHEA-S], androstenedione, testosterone, 17-OH progesterone), and serum estradiol in men and postmenopausal women .

Radiologic imaging studies like computed tomography (CT) scanning can usually distinguish adenomas from Adrenocortical carcinomas. Positron emission tomography (PET) scanning with fluorodeoxyglucose (FDG) is of value for distinguishing Adrenal Adenoma from Adrenocortical Carcinoma. The most common sites of distant spread for ACC are the liver, lungs, lymph nodes, and bone.  If ACC  is suspected, CT imaging  of the chest and liver as well as bone scan are typically included in the staging workup.

Fine-needle aspiration biopsy — Cytology from a adrenal biopsy cannot distinguish a benign adrenal mass from adrenal carcinoma. However,  FNA can distinguish between an adrenal tumor and a metastatic tumor from other parts of the body.

Prevention

There are no known lifestyle changes to lower the risk of developing adrenal gland tumors. However reducing obesity, smoking, alcohol will help you in reducing the chances of developing cancers in general.

Certain genetic  disorders can increase your risk of having an adrenal disease. These  syndromes include:

  • Von Hippel-Lindau Syndrome (VHL)
  • Beckwith-Wiedemann syndrome
  • Li-Fraumeni syndrome (pdf)
  • Multiple Endocrine Neoplasia type 2 (MEN2)
  • Neurofibromatosis type 1, also known as von Recklinghausen’s disease
  • Paraganglioma syndrome

 If you have any family member diagnosed with any of the above syndromes,  your doctor may order genetic  testing.

Education

We offer a depth of cancer resources for our patients and their caregivers.  You may find educational documents, cancer information  on adrenal tumors at  links listed below :

The following organizations also provide reliable health information.

  • National Library of Medicine

    (www.nlm.nih.gov/medlineplus/healthtopics.html)

  • Hormone Health Network

    (www.hormone.org available in English and Spanish)

  • National Institute of Diabetes and Digestive and Kidney Diseases

    (http://endocrine.niddk.nih.gov/index.htm)

  • National Adrenal Diseases Foundation

    (516) 487-4992

    (www.nadf.us)

  • Pituitary Tumor Network Association

    (www.pituitary.org)

  • Cushing's Support & Research Foundation

    (617) 723-3674

    (http://csrf.net/)

 

Treatment

Because  we are  experts  in Cancer care for more patients with adrenal gland tumor than most other programs in  West Coast of Florida, we have a higher level of experience that can have a direct impact on your chance for successful cure.

We have expertise in both minimally invasive ( Laparoscopic and Robotic ) approach to removal of benign or functional Adrenal tumors.  If you are diagnosed with Malignant Adrenal tumors, minimally invasive approach is not recommended as it has higher rates of recurrence.

On your consultation, we will discuss the details of  all the possible approaches to successfully removal of the adrenal tumor. We will also discuss the risk, benefits and postoperative recovery in details.  You may need  post operative chemotherapy , hormone replacement  after removal of the adrenal gland. We will work in close association with your oncologist and primary care physician to make sure that you get the recommended postoperative care.