Each person has two adrenal glands—one located on top of each of the body’s two kidneys. These glands are important to the body’s endocrine (hormonal) system.
Each adrenal gland has two main parts that function separately:
Adrenal Cortex
The outer part of the adrenal gland is called the cortex. The adrenal cortex makes three main hormones: cortisol, aldosterone, and dehydroepiandrosterone (DHEA). These hormones carefully control metabolism and body characteristics, such as hair growth and body shape.
Adrenal Medulla
The gland’s inner part is called the medulla. The adrenal medulla makes other hormones: epinephrine, norepinephrine, and dopamine. These hormones control the body’s responses to stress, including the “fight or flight” adrenaline surge.
Types of Adrenal Gland Tumors
A tumor begins when normal cells change and grow uncontrollably, forming a mass. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body).
An adrenal gland tumor can sometimes overproduce hormones. When it does, the tumor is called a functioning tumor. An adrenal gland tumor that does not produce hormones is called a nonfunctioning tumor. A tumor can start in an adrenal gland (called a primary adrenal tumor), or it can begin in another organ, such as the lungs, and then metastasize (spread) to the adrenal glands. The symptoms and treatment of an adrenal gland tumor depend on whether the tumor is functioning or nonfunctioning, what hormone(s) is overproduced, and whether the tumor is a primary adrenal gland tumor or a metastases from cancer of another organ.
This section focuses on primary adrenal gland tumors, which include the following:
Adenoma
Adenoma is the most common type of adrenal gland tumor, making up the majority of all adrenal gland tumors. It isa noncancerous, nonfunctioning tumor of the adrenal cortex. Also called an adrenocortical adenoma, this tumor usually does not cause symptoms and, if it is small, often does not need treatment.
Adrenocortical Carcinoma
Although rare, the most common type of cancerous adrenal gland tumors begins in the cortex and is called adrenocortical carcinoma, or adrenal cortical carcinoma. Approximately four to 12 out of one million people develop this type of tumor. Adrenocortical carcinoma can be a functioning or nonfunctioning tumor; if the tumor is functioning, it may produce more than one hormone.
Neuroblastoma
This is a type of childhood cancer that can begin in the adrenal medulla.
Pheochromocytoma
This type of cancerous neuroendocrine tumor most often begins in the adrenal medulla.
Diagnosis
Doctors use many tests to diagnose a tumor, find out if it is cancerous, and if so, whether it has metastasized. Some tests may also determine which treatments may be the most effective. To diagnose an adrenal gland tumor, blood and urine tests (see below) are done to look for certain substances that may indicate that cancer is present. If there is no evidence that the cancer has spread to the adrenal gland from another part of the body, the diagnosis can be made with a computed tomography (CT or CAT) scan or a magnetic resonance imaging (MRI) scan (see below). Imaging tests may also be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
- Age and medical condition
- Type of tumor suspected
- Severity of symptoms
- Previous test results
In addition to a physical examination, the following tests may be used to diagnose an adrenal gland tumor:
Blood and Urine Tests
Blood tests can measure the amounts of natural hormones, such as catecholamines and metanephrines, produced during stress, which can detect a functional tumor. A patient may be asked to take a pill on the evening before the blood and urine tests, which helps detect the normal suppression of production of the hormone cortisol. A 24-hour urine sample, which requires the collection of all urine during that timeframe for laboratory testing, may also be needed. This helps the doctor track how quickly various hormones are produced. Tell your doctor about any medications that you take, even over-the-counter drugs, because this information is needed to correctly interpret the results.
Biopsy
A biopsy is the removal of a small amount of tissue for examination under a microscope. For an adrenal tumor, a narrow, hollow needle is used to collect the tissue; this is called a fine needle biopsy or fine needle aspiration. If the doctor suspects adrenal cancer, a biopsy of the adrenal gland is not recommended because it could help the cancer to spread. However, if the doctor suspects that cancer has spread to the adrenal gland from another area of the body where the cancer started, a biopsy may be done to determine the type of cancer, which can help the doctor plan treatment. The biopsy is performed by a radiologist who uses specialized imaging procedures, such as CT or MRI scans (see below) to direct the needle. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
CT scan
A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.
MRI
An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium is injected into a patient’s vein to provide better detail.
Metaiodobenzylguanidine (MIBG) Scan
MIBG is a chemical similar to adrenaline that will collect in a neuroendocrine tumor. A MIBG scan can show a tumor of the adrenal medulla that may not appear in an x-ray. The scan takes place over two consecutive days. On the first day, an injection of MIBG is given in the arm. Several hours later, pictures are taken with a special camera that can detect if or where in the body the MIBG has collected. The following morning, more pictures are taken, and the process may be repeated if needed.
After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is a tumor, these results also help the doctor describe it; this is called staging.
Treatment
Treatment options and recommendations depend on several factors, including the type and stage of the tumor, possible side effects, and the patient’s preferences and overall health.
Surgery
Surgery is the removal of the tumor and surrounding tissue during an operation. Adrenalectomy, which is the surgical removal of the adrenal gland with the tumor, may be needed to treat an adrenal gland tumor. A surgical endocrinologist is a surgeon who specializes in treating an endocrine tumor using surgery.
If the tumor is smaller than 5 cm and, based on size or the way it looks on imaging scans, shows no evidence that it is cancerous, then laparoscopic surgery may be possible. Laparoscopic surgery is a minimally invasive technique in which a surgeon uses a lighted, flexible, tube instrument and makes small incisions in the skin; the technique minimizes pain and post-operative recovery time compared with traditional incisions. It may be performed from the abdomen or back, depending on the location of the tumor and the experience of the surgeon.
However, if the tumor is possibly cancerous or larger than 5 cm to 6 cm, surgery using one large incision in the abdomen or back is recommended. If the patient has previously had abdominal surgery, an incision in the back may be easier.
Surgery is the main treatment for a pheochromocytoma.
If the surgery is performed laparoscopically, the person can usually leave the hospital in two to three days and resume daily activities within a week. If a larger incision is needed, then the person is usually hospitalized for up to five to seven days and should not lift heavy objects for six weeks after surgery.
Adrenal surgery can cause bleeding. The tumor can also make excess catecholamines (stress hormones), and the patient will need to be monitored and receive medication to treat high blood pressure during surgery.
Recovery
After treatment for an adrenal gland tumor ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.
If the adrenal gland that did not have the tumor is still functional after surgery, it should be able to provide enough of the hormones needed by the body. Sometimes, a person needs hormone replacement therapy (such as steroids) because the body can’t produce enough hormones. Over time, the person often can decrease the dosage and even stop taking the hormone replacement drug. An endocrinologist (a doctor who specializes in problems of the endocrine system) should carefully monitor this process.
The endocrine system is a complex collection of hormone-producing glands that control many essential functions. If both adrenal glands have been removed, long-term medication is needed to replace the hormones normally produced by these glands, and you should wear a medical-alert bracelet to inform caregivers of your condition in case you ever become sick or unconscious and are unable to do so