What is an adrenal tumor?
The adrenal glands are a pair of small endocrine glands located above the kidneys. As part of the endocrine system, they respond to signals from the nervous system and secrete hormones that regulate stress. The adrenal glands also produce hormones that help maintain metabolism and distinguish male and female physical and sexual characteristics.
Three categories of tumors that can develop in the adrenal glands:
- Most growths are benign, and symptoms are treatable.
- Malignant (cancerous) adrenal tumors are rare and generally grow as a result of metastasizing cancer that originated in a different organ.
- Functioning tumors in the adrenal glands are typically benign but capable of becoming cancerous in the future.
Symptoms and risk factors
What are the symptoms of an adrenal gland tumor?
Adrenal gland tumors do not always present the same group of symptoms, and some may not cause any symptoms at all. In addition, symptoms may vary based on the type of tumor, where it is located, and the hormone affected by it. The following symptoms may be warning signs:
- Unusual weight changes
- Unusual anxiety
- Heart palpitations or elevated blood pressure
- Unusual hair growth
- Disproportionate acne
- Diminished sex drive
- Muscle weakness
- Easy bleeding or bruising
Who is at risk of developing an adrenal tumor?
People with certain genetic conditions are at a higher risk of developing adrenal tumors. These include:
- Li-Fraumeni syndrome
- Carney Complex
- Family history of adrenal tumors
Screening and prevention
Can adrenal tumors be detected early?
It's hard to catch tumors in the adrenal gland early because there are no routine screening tests used to find them. In most instances, adrenal tumors are found incidentally on imaging tests for an unrelated health concern. In addition, there are no modifiable risk factors for this type of tumor, so there is nothing you can do to prevent this condition.
How are adrenal tumors diagnosed?
If you have signs or symptoms of an adrenal tumor or cancer, your doctor will collect information about your medical history and your family history of cancer. They'll also conduct a physical exam and may order additional tests, such as:
Biopsy: A small amount of tissue from the adrenal gland may be removed with a fine needle to examine it for any evidence of cancer. We reserve this for patients who have advanced adrenal tumors that appear to be cancer and cannot be removed surgically to make the diagnosis of cancer or for patients who have cancers in other parts of the body that appear to have spread to the adrenal gland.
Blood and urine tests: Hormone levels produced under certain circumstances are present in blood and urine and may indicate possible tumors.
Imaging: With either a computed tomography (CT) scan or MRI, your physician can verify the existence of an adrenal tumor and determine its exact size and placement.
Metaiodobenzylguanidine scan (MIBG): This is a special test administered during the course of two days. It is designed to show adrenal tumors that are not evident on other scans. On the first day, a patient gets an injection followed by a scan with a special camera. The next day, the scan is repeated.
Adrenal vein sampling: This test can allow us to figure out which of the adrenal glands is overproducing hormones, either in patients with tumors of both glands or with hyperplasia (overgrowth) of the glands that do not clearly have a tumor.
Types of adrenal tumors
The kidneys, responsible for cleaning and purifying the blood, are located inside the upper part of the abdomen. Sitting above each of the kidneys, you will find the adrenals, small glands made up of two parts:
- Cortex: The outer part of the gland, which produces important hormones for the body.
- Medulla: The inner part of the gland, which is an extension of the nervous system.
The adrenal cortex is where tumors and cancers can develop; however, they are rare, and most are benign (non-cancerous). Two main types of adrenal cortex tumors exist:
- Adenomas: Most tumors of the adrenal cortex are benign adenomas. These are small tumors, usually less than 5 centimeters (about 2 inches) in diameter. They usually occur in only one adrenal gland, but sometimes affect both glands.
- Carcinoma: The type of cancer that develops in the cortex of the adrenal gland is called adrenal cortical carcinoma. Generally, adrenal cortical cancers are much larger than adrenal adenomas. An adrenal tumor larger than 5 or 6 centimeters (about 2-2.5 inches) is usually malignant or cancerous. In one study, the average size was about 4-5 inches.
The most common subtypes of adrenal tumors include:
- Adrenocortical carcinoma, a rare disease in which cancer forms in the cortex (outer layer) of an adrenal gland.
- Adrenal cortex tumors, which produce excessive cortisol (stress hormone) and may cause a condition called Cushing’s syndrome.
- Aldosteronomas, tumors that produce excessive aldosterone and commonly cause Conn syndrome, or hyperaldosteronism.
- Incidentalomas, enlarged adrenal glands that have a risk of being adrenal cancer.
- Pheochromocytoma, a type of neuroendocrine tumor (made up of both nerve and hormone producing cells), is a rare and usually benign tumor that develops in cells in the center of an adrenal gland. This type of tumor is genetic and runs in families.
How are adrenal cancers and tumors treated?
If you have an adrenal tumor, your treatment is based on the tumor's size, location, and whether or not it is cancerous. A team of experts will work together to design a treatment plan based on your unique needs, with input from specialists in endocrinology, surgery, medical oncology, radiation oncology, interventional radiology, and nuclear medicine, when appropriate.
For most patients, surgery to remove the adrenal gland is the best treatment option. It can be used alone or, in some cases of adrenal cancer, in combination with radiation or chemotherapy. When additional therapies are needed, our endocrine surgical team works collaboratively with other specialists at MedStar Health to develop a comprehensive treatment plan.
Some patients will be treated with open surgery. This is traditionally used for larger adrenal tumors or tumors attached to other nearby organs. It requires larger incisions, usually made through the abdomen.
Our surgeons are particularly skilled at a less-invasive surgical procedure that is an option for an increasing number of patients called a laparoscopic adrenalectomy. In this procedure, adrenal tumors are removed through small incisions measuring one to two centimeters along the abdominal wall. This speeds recovery, minimizes scarring, and lowers the risk of injury to abdominal organs.
Chemotherapy uses drugs to target cancerous cells throughout the body. If you have an advanced form of adrenal cancer and/or are not a good candidate for surgery, chemotherapy may be used to treat your disease. The most common type of chemotherapy used for adrenal cancer is taken orally via a pill, either alone or in combination with other drugs. If this is an appropriate treatment option for you, your care team will monitor your body's response to it and help you manage any side effects as you undergo treatment.
Depending on your adrenal tumor type, your doctors may recommend drugs that block or reduce the effects of hormones. This can help to relieve side effects of cancerous tumors.
Immunotherapy and targeted therapy
Immunotherapy leverages the body's own immune system to target and change how cancerous cells grow. While this treatment is more commonly used to treat other types of cancer, it was recently approved for use in certain cases of metastatic adrenal cancer.
Radiation therapy uses high-energy X-rays or particles to pinpoint and destroy cancer. While radiation therapy is a common treatment for other types of cancer, it is not frequently used as a main treatment for adrenal cancer. However, it may be appropriate in certain instances, such as after surgery to kill any remaining cancerous cells or if cancer has spread to the bones or brain. With access to all of the latest technologies in radiation therapy, our radiation oncologists are skilled at using the most advanced therapies to deliver targeted radiation for precise treatment that spares as much healthy tissue as possible.
Why choose us
At MedStar Health, your treatment is as unique as you are, considering the type, size, location, and hormone-producing capability of your adrenal tumor. Patients choose us for care because:
We combine the expertise of several specialists to improve your outcomes and quality of life. Depending on whether or not your adrenal tumor is cancerous, you'll benefit from the input of a team of experts in several specialties, including:
- Endocrine surgery
- Medical oncology
- Radiation oncology
- Interventional radiology
- Nuclear medicine
- and more
Focusing exclusively on diagnosing and treating endocrine cancers, these experts meet regularly to discuss each patient in a multidisciplinary tumor board. Working as a team, we consider all of your treatment options to ensure the best possible results now and in the future.
We offer a full range of the most advanced treatments available, delivered with compassion. Adrenal cancer is rare, which is why it's important to seek care from a team with experience in diagnosing and treating all types of the disease. At MedStar Health, we'll help you understand all of your treatment options, from surgery to innovative therapies backed on the latest research. From your first visit through treatment and follow-up, you can expect patient-centered and personal care that puts your needs first.
When surgery is your best treatment option, our surgical experts will determine the right approach for you. Our surgeons have exceptional skill and experience in both traditional surgeries and minimally invasive techniques, such as laparoscopic surgery which offer less risk and faster recoveries. Because we perform a high number of these procedures to remove adrenal tumors every year, we have extensive expertise in preserving critical hormone functions, preventing future tumor recurrence, and maximizing your quality of life.
Awards and recognition
Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)
Magnet® designation from the American Nurses Credentialing Center (ANCC)
Clinical trials and research
A clinical trial investigates safer, more effective ways to treat cancer. These studies test newer drugs, drug combinations, or treatment techniques to see how well they work. When available, our team may recommend a clinical trial as part of your treatment plan.
Our endocrinologists and cancer doctors are dedicated to advancing care for endocrine tumors and disorders. Through our research engine, Georgetown University's Lombardi Comprehensive Cancer Center, we continue exploring how to best prevent, diagnose, and treat these conditions.
If you have cancer, you'll benefit from a wide range of programs and services designed to care for all of your needs--not just the physical. From counseling and peer support to specialty care to manage side effects of treatment or your tumor, we're here for you.
A small percentage of cancerous adrenal tumors are linked to hereditary gene mutations, which means that other family members may also be at risk for developing the same type of cancer. Our board-certified genetic counselors can help you and your family understand any familial cancer risk and determine appropriate strategies for mitigating that risk.
If adrenal cancer zaps your energy, stamina, and quality of life, you may benefit from working with a physical or occupational therapist. Our cancer rehabilitation services are tailored to you based on your unique needs and goals as you work to regain strength and mobility affected by cancer.
Follow-up care after adrenal cancer is important, and your doctor will want to see you in the months and years after treatment. Your personalized survivorship plan may include a suggested timeline for follow-up visits and tests, warning signs to watch for, and lifestyle modifications to help you optimize your overall health.