Adrenal Tumours: Comprehensive Health Information

This information is provided by SSCHRC to help you understand adrenal tumours and their management. It is written in a patient-friendly and medically accurate style.

1. General Information

Adrenal tumours are growths that develop on the adrenal glands. These glands are a crucial part of the endocrine system, responsible for releasing vital hormones into the bloodstream. These hormones are essential for numerous bodily processes, including metabolism, sexual development, and the body's response to stress.

The Adrenal Glands

There are two adrenal glands, each positioned on top of a kidney. Shaped like small triangles, each gland is divided into two distinct parts:

Medulla (Inner Part)

This section produces hormones called catecholamines, which include adrenaline and noradrenaline. These are often referred to as "stress hormones," as they are released in emergencies to increase alertness, strength, and speed. They also regulate heart rate, blood pressure, and sweating.

Cortex (Outer Part)

The cortex produces hormones that regulate blood pressure, metabolism, and how the body uses fats, carbohydrates, and proteins.

Adrenal tumours can be classified as either malignant (cancerous) or benign (non-cancerous). Even benign tumours can be dangerous or cause distressing symptoms due to excessive hormone production.

Malignant Adrenal Tumours

Adrenocortical Carcinoma (ACC)

These tumours develop in the adrenal gland's cortex and are rare. They are broadly categorised as:

Functioning Tumours

The most common type (accounting for about 70% of adrenal cancers), these tumours produce excess hormones such as cortisol, androgens, or aldosterone.

Non-functioning Tumours

These tumours do not produce excess hormones.

Malignant Adrenal Pheochromocytoma

An extremely rare form of cancer that originates in the medulla.

Malignant Paragangliomas

These tumours can begin either within or outside the adrenal gland.

Benign Adrenal Tumours

Adenomas

A common type of non-cancerous growth.

Benign Pheochromocytomas

Non-cancerous tumours of the adrenal medulla.

Benign Paragangliomas

Non-cancerous tumours that can occur in or outside the adrenal gland.

Related Conditions

Cushing's Syndrome

This rare condition is caused by the adrenal gland producing an excessive amount of cortisol, a hormone that helps regulate blood pressure, heart function, and the stress response. Overproduction of cortisol can be caused by a benign tumour (adenoma) on the adrenal gland, an abnormality of the pituitary gland (Cushing's disease), or long-term use of corticosteroid medications.

Hyperaldosteronism

This condition is caused by a small tumour in the adrenal gland that makes too much aldosterone, or by an enlargement of the glands (hyperplasia). High aldosterone levels affect the body's salt and potassium balance and are a recognised cause of high blood pressure.

Adrenal Cancer Staging (Adrenocortical Carcinoma)

The stage of a cancer indicates the size of the primary tumour and how far it has spread. Staging is crucial for treatment planning and determining prognosis.

TNM Staging System

This system is widely used, describing cancer based on three factors: Tumour size, spread to nearby lymph Nodes, and Metastasis (spread to distant parts of the body).

Simplified Stages (I to IV)

Stage I

The tumour is 5 centimetres or smaller and confined only to the adrenal gland.

Stage II

The tumour is larger than 5 centimetres and confined only to the adrenal gland.

Stage III

The tumour is any size and has spread to nearby lymph nodes, or to nearby tissues/organs (such as the kidney, liver, pancreas, etc.), and may involve large blood vessels.

Stage IV

The tumour is any size, may have spread to nearby lymph nodes, and has spread to distant parts of the body (e.g., lung or bone). This is also known as metastatic cancer.

Adrenal Tumour Risk Factors

Certain inherited disorders can increase the risk of developing an adrenal disease. These include:

Li-Fraumeni syndrome

Multiple Endocrine Neoplasia type 2 (MEN2)

Von Hippel-Lindau disease (VHL)

Neurofibromatosis type 1

Paraganglioma syndrome

Beckwith-Wiedemann syndrome

A doctor may recommend genetic testing if you or a family member has one of these syndromes, though not everyone with these syndromes will develop an adrenal tumour.

2. Symptoms

Adrenal gland tumours may or may not cause noticeable symptoms, which largely depend on the type of hormone the tumour is producing. Potential symptoms may include:

General Symptoms

  • High blood pressure (hypertension)
  • Excess fat in the upper back or neck ("buffalo hump")
  • A round, full face ("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

Additional Symptoms

  • Headaches
  • Rapid or irregular heartbeats
  • Feelings of anxiety, panic, or fear
  • Pallor (paleness)
  • Dizziness or lightheadedness upon standing
  • Tremors
  • Sweating

In Women

Excess facial and body hair, deepening of the voice, or problems with menstruation.

In Men

Breast tenderness or enlargement, lowered sex drive, and/or erectile dysfunction.

Important Note: It is important to discuss any symptoms with a doctor, as they can also be signs of other health conditions.

3. Diagnosis

Adrenal gland tumours are varied and can be complex to diagnose. It is essential to consult an endocrinologist who is highly experienced in adrenal gland tumours to recommend the correct tests and analyse the results.

The experts at SSCHRC utilise the latest techniques and technology to provide the most accurate and concise diagnosis possible. Diagnostic procedures may include:

Blood Tests

To check the levels of specific hormones, including cortisol, aldosterone, plasma metanephrines, and dehydroepiandrosterone (DHEA), as well as chemicals like sodium and potassium.

Urine Tests

These often include 24-hour urine collection tests to measure hormone output.

Diagnostic Imaging Tests

These scans help locate the tumour and determine its size and spread. Options may include:

  • CT (Computed Axial Tomography) scans
  • MRI (Magnetic Resonance Imaging) scans
  • PET (Positron Emission Tomography) scans
  • MIBG (Meta-iodobenzylguanidine) scans
  • Radiographic scanning
  • Adreno-venous sampling

Genetic Testing and Counselling

Available if your family members have certain inherited disorders, to assess your risk of developing adrenal gland tumours.

There are no known lifestyle changes that can lower the risk of developing adrenal gland tumours.

4. Treatment

If an adrenal gland tumour is diagnosed, your doctor will discuss the optimal treatment plan. This plan will be customised to your particular needs, considering the type of disease, its stage, and your general health.

The accomplished surgeons at SSCHRC perform a large number of surgeries for adrenal gland tumours each year, using the least invasive and most effective techniques. They are highly skilled in minimally invasive laparoscopic procedures, which may offer advantages such as shorter hospital stays, less blood loss, and quicker recovery times compared to standard surgical techniques.

One or more of the following therapies may be recommended to treat the disease or help alleviate symptoms:

Surgery

To remove one or both adrenal glands.

Systemic Therapies

These may include:

  • Chemotherapy
  • Molecular targeted therapies
  • Nuclear medicine agents

Medicines

Medications may be prescribed to balance levels of hormones produced in excess, or to replace deficient hormones.

SSCHRC is also at the forefront of discovering new treatment advancements and may be able to offer clinical trials for some adrenal gland tumours.