Adrenal gland tumors: signs, symptoms, & treatments

What are adrenal gland tumors?

Adrenal glands, located on top of your kidneys, are layered parts of your endocrine system that are responsible for creating certain hormones. 

The cortex layer of the adrenal glands produces cortisol and aldosterone, while the medulla layer of the adrenal glands produces epinephrine, norepinephrine, and dopamine.

When tumors develop inside the adrenal glands, they either do nothing (non-functioning tumors) or produce an excess of one or more hormones (functioning tumors). Generally speaking, non-functioning tumors do not require treatment and actually tend to be found incidentally during CT or MRI scans for something unrelated.

Functioning tumors, which account for about 70% of adrenal tumor cases, cause symptoms that are likely to prompt you to seek medical treatment and, soon after, diagnostic medical imaging. Surgical removal is recommended in some cases.

How are adrenal gland tumors diagnosed?

Blood tests, which look at stress hormone levels and other important markers.

Imaging scanswith diagnostic capabilities, like MRI and CT.

Biopsies, which determine whether the tumor is benign (noncancerous) or malignant (cancerous). Metaiodobenzylguanidine scans. If a biopsy shows the tumor is malignant, this scan will indicate the size, the stage of the cancer, and whether it’s spread to the lymph nodes or metastasized in other parts of the body.

What are the symptoms of adrenal gland tumors?

Adrenal tumors generally fall into one of four categories: adenomas, pheochromocytomas carcinomas, or neuroblastomas. Some adrenal tumors will be malignant, but most will be benign. Symptoms of functioning adrenal tumors will vary by type.

Adenomas. Adenomas are benign tumors, but can still have side effects. Functioning adrenal adenomas overproduce adrenal hormones like aldosterone and cortisol.

• Excess production of cortisol results in a condition called Cushing’s Syndrome, which can result in diabetes, high blood pressure (hypertension), sexual dysfunction, and obesity.

• Excess production of aldosterone causes Conn’s syndrome, which can cause high blood pressure, weakness, constipation, excessive urinating, and even personality changes.

Pheochromocytomas.The main symptom of pheochromocytoma, a benign adrenal tumor, is high blood pressure (hypertension). In addition to hypertension, the following symptoms are also commonly reported:

• Feeling like your heart is racing, pounding dramatically, or fluttering (palpitating)
• Tremors
• Anxiety
• Sweating or clammy skin
• Headache
• Nausea and/or vomiting

Carcinomas.When an adrenal gland tumor is cancerous, it’s called an adrenocortical carcinoma. These tumors are more common in women than men and tend to have a genetic component, but are overall exceedingly rare, accounting for only 1 of every 1 million cancer cases diagnosed each year. Symptoms of adrenocortical carcinoma include:

• Weight gain only in the face and neck
• Excess facial hair on women; breasts on men (gynecomastia); early puberty in either sex
• Abdominal pain
• High blood pressure or high blood sugar

Neuroblastomas.These pediatric cancers grow in the nerve tissue of babies and young children.³Neuroblastomas most often start the adrenal glands or abdominal nerve fibers. When a neuroblastoma acts on hormones, it creates something called paraneoplastic syndrome. Symptoms of this condition include:

• Sweating and/or flushing
• Fast pulse
• Constant diarrhea
• High blood pressure
• Fever

What causes adrenal gland tumors?

Most adrenal tumors do not have clear causes. However, certain genetic risk factors may predispose you to a higher risk of developing adrenal tumors:

• Carney complex is a rare genetic disorder that results in spotty skin pigmentation and benign tumors that typically affect the skin, endocrine (hormone) system, and heart.⁴
• Neurofibromatosis type 1 is a condition that causes tumors to grow along the skin and brain. It also affects pigmentation.
• Li-Fraumeni syndrome is a rare mutation on gene TP53, which is responsible for tumor suppression. People with this syndrome are incredibly vulnerable to developing certain cancers, including adrenocortical carcinoma.
• Multiple endocrine neoplasia type 2 (MEN2) is a rare genetic disorder that increases susceptibility to tumors in the adrenal glands, thyroid gland, or parathyroid glands.⁵This can cause high blood pressure and kidney stones, among other symptoms.

Von Hippel-Lindau Disease (VHL) is a mutation on the gene that controls cell growth. When cell growth is poorly controlled, tumors and cysts are more likely to form.

Resources:

1. clevelandclinic.org: Adrenal Tumors
2. mdanderson.org: von Hippel-Lindau Disease
3. stanfordchildrens.org: Neuroblastoma
4. rarediseases.org: Carney Complex
5. cancer.gov: multiple endocrine neoplasia type 2 syndrome