Adrenal cancer

Overview

Several tumor types can develop in the adrenal glands, which sit on the kidneys. These two small glands produce hormones which help to control certain bodily responses, a balance frequently disrupted by tumors. 

Our approach

Tumors that start in the adrenal glands usually aren’t cancerous and often don’t require treatment. But a specialized cancer center like at Northwell Health is the best place to find the expertise required when adrenal tumors disturb hormones or produce cancerous cells.

Sometimes adrenal gland tumors are discovered because they are causing problems with hormone production. Many times, though, they are spotted inadvertently during medical scans for other reasons — non-cancerous adrenal tumors are fairly common in patients who are middle-aged or older. 

Regardless, the prognosis is usually good: Benign tumors may not need treatment, and cancerous tumors are often curable if found early. The skilled pathologists on the adrenal team know how to draw the critical distinction between malignant and cancerous tumor cells — not always an easy task because of their similarities under the microscope.

With care, even cancerous adrenal tumors can be cured. Taking out an adrenal gland still leaves patients with a good prognosis.

Risk factors

Doctors don’t know what causes most adrenal gland tumors. But approximately a quarter of cases are connected to inherited conditions that run in families and raise the risk of developing a tumor. These disorders include:

  • Li-Fraumeni syndrome: a genetic mutation that raises the chance of developing several types of cancer
  • Beckwith-Wiedemann syndrome: Patients with the disorder have larger tongues and bodies and have a higher risk for certain cancers
  • Multiple Endocrine Neoplasia (MEN1): a genetic mutation that raises the risk of developing benign tumors (adenomas and pheochromocytoma), though patients usually don’t experience symptoms
  • Familial Adenomatous Polyposis (FAP): a genetic mutation that can increase the risk of developing (usually benign) adrenal gland tumors

Symptoms

Adrenal gland tumors don't always cause noticeable problems, and may get discovered during medical scans taken for other reasons. But some tumors spur hormone production, leading to changes in the body and warning signs. Cancerous tumors can also grow and press on abdominal organs.

Adrenal tumor symptoms depend on which hormones are involved, but can include:

  • Weight gain in the face, neck and torso, but thin arms and legs
  • Hair growth on the face, upper back or arms
  • A round, red face
  • A lump on the back of the neck
  • Deepened voice
  • Swelling of the sex organs or breasts
  • Muscle weakness or cramps
  • Higher blood sugar
  • Higher blood pressure
  • Frequent urination
  • Excess thirst
  • Acne (women only)
  • Balding (women only)
  • Disrupted menstruation
  • Vaginal bleeding in post-menopausal women
  • Lower sex drive (men only)
  • Impotence

Growing, cancerous tumors can also cause symptoms unrelated to hormones:

  • Abdominal lump
  • Back or abdominal pain
  • Feeling of fullness

Just because someone has some of these symptoms does not necessarily mean they have an adrenal gland tumor. A doctor should determine the cause.

Types

The adrenal gland is made of two sections: the cortex, or outer layer, and the medulla, or center. Different tumors develop in these sections:

  • Adenoma (cortex): Most common type of adrenal gland tumor, but non-cancerous
  • Adrenocortical Carcinoma (cortex): Rare but cancerous
  • Neuroblastoma (medulla): Cancerous
  • Pheochromocytoma (medulla): Usually benign, rarely cancerous 

Diagnosis

If an adrenal tumor is suspected, a doctor will choose from a series of scans and tests to assess hormone levels or physical changes. These could include:

  • Physical exam: looking for lumps or other physical changes
  • Urine and blood tests: measuring the levels of hormones or other substances, such as potassium or sodium
  • CT scan (CAT scan): overlapping X-rays from different angles, with dye sometimes injected into veins or swallowed to give doctors a view of delicate, tiny structures
  • MRI (magnetic resonance imaging): using a magnet, radio waves and a computer to take detailed pictures of the inside of the body
  • Adrenal angiography or venography: injecting a contrast dye into veins or arteries, then taking X-rays to check blood flow near the adrenal glands
  • PET scan (positron emission tomography scan): injecting glucose (sugar) into the veins and using a rotating scanner to look for malignant cells throughout the body, not just where the cancer first started to grow
  • MIBG scan: injecting a small, safe amount of a radioactive material called MIBG, then watching as it travels through veins to adrenal gland cells
  • Biopsy: removing tissue for a pathologist to examine under a microscope

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