Adrenal Masses’ Symptoms and Treatment

Overview

What is an adrenal mass?

Adrenal masses include any abnormal growth in the adrenal glands. They are not common, affecting about 9% of the United States population. Their cause is not known. Adrenal masses can cause hormone levels to change, resulting in a variety of symptoms including high blood pressure, weight changes and sexual health issues.

Who can get adrenal masses?

Adrenal masses can develop in anyone, at any age. They are more common in older people. 

What are adrenal glands?

There are two adrenal glands, located above each kidney. Adrenal glands are critical for good health because they control many bodily functions. The adrenals keep the body in balance by regulating fluid and salt levels, which affect blood pressure and blood volume. They help the body deal with stress by providing a burst of energy when needed.

These small glands have two layers. Each layer produces different hormones. In the inner layer (adrenal medulla) hormones control blood pressure, heart rate, sweating, and help manage stress. 

The outer layer (adrenal cortex) makes cortisone, aldosterone and other steroid hormones. Cortisol helps the body break down blood sugar (glucose), and react to stress. It regulates metabolism, blood pressure, salt and potassium levels, and sex hormones.

What are adrenal tumors?

Like adrenal masses, adrenal tumors develop on the adrenal glands. They are classified as either functioning or nonfunctioning, and as cancerous or noncancerous (benign). These tumors rarely become cancerous and usually have no symptoms. 

Causes

What causes adrenal masses?

In the majority of cases, the cause of adrenal masses and adrenal tumors is unknown. Some adrenal gland problems can be caused by a disease or a mass in or around the glands. They can be caused if the hypothalamus or the pituitary gland fail to make the essential hormones needed to control the adrenal glands. Long-term use of corticosteroid medications can also trigger adrenal problems.

Who’s at risk of developing adrenal masses?

You may have a higher risk of developing adrenal masses if you or a family member has:

• Carney complex
• Li-Fraumeni syndrome, a type of breast cancer
• Multiple endocrine neoplasia type 2, a rare genetic condition where noncancerous tumors form in the body’s endocrine system
• Neurofibromatosis type 1, causes numerous tumors on nerve cells
• Von Hippel-Lindau disease
• Paraganglioma syndrome
• Beckwith-Wiedemann syndrome
• Familial adenomatous polyposis (FAP), a rare condition that causes hundreds of noncancerous polyps to grow in the large intestine and upper respiratory tract. If left untreated, it usually leads to colon cancer.

Because these disorders are inherited, if you or a family member has one of these syndromes, you may need genetic testing. 

Symptoms

What are the symptoms of adrenal masses or tumors?

Most adrenal masses and tumors don’t cause symptoms. However, if you have a functioning tumor it means the tumor makes the same hormones as your adrenal glands. It is the imbalance of too many or too few hormones that cause symptoms. 

These imbalances can cause:

• Easy bruising
• High blood pressure
• Heart palpitations
• High blood sugar
• Diabetes
• Muscle weakness
• Low potassium
• Sweating
• Fat deposits on the neck
• Excessive hair growth
• Osteoporosis 
• Stretch marks on abdomen
• Mental health issues including depression, anxiety or panic attacks

Other very rare adrenal problems include:

• Adrenal gland cancer.
• Conn’s syndrome (hyperaldosteronism) can happen when the glands make too much aldosterone hormone, causing high blood pressure, low potassium levels, weakness, muscle cramps, excessive urination, constipation and personality changes.
• Cushing syndrome can happen when the glands make too much cortisol hormone. It is generally caused by a tumor or mass in the pituitary gland, or a non-cancerous tumor in the adrenal glands. It causes weight gain in your abdomen, a very round face, stretch marks on your skin, high blood pressure and sexual dysfunction. It can make you more likely to develop diabetes, and can lead to mood swings.
• Sex hormone production problems in women can cause irregular or no menstrual periods and hair loss. In men, they can cause a lowered sex drive and erectile dysfunction. 
• Tumor in the adrenal medulla, also called pheochromocytoma, rarely becomes cancerous but can cause high blood pressure, sweating, headaches, heart palpitations, anxiety, weakness and weight loss.

Diagnosis

How are adrenal masses diagnosed?

You may have a blood draw to evaluate the health of your kidneys, liver, and to test your glucose, blood proteins and minerals (electrolytes). Your doctor may also use an MRI or CT scan to increase the accuracy of an adrenal mass diagnosis. These tests also provide information that will guide your treatment. 

How are adrenal tumors diagnosed?

In addition to the blood tests described above, urine may need to be collected for 24 hours. A biopsy may be done to determine if the tumor is a metastasis from cancer of another site pr staging for a known cancer. If it’s cancerous, staging will be done to determine the size and location. Staging will also determine if it has spread to the lymph nodes or other parts of the body. 

Treatments

Can adrenal masses or tumors be treated? 

Treatment is determined by your specific diagnosis. If you have a:

• Nonfunctioning tumor, which does not produce hormones, you’ll only need regular monitoring. Your doctor will check that the tumor hasn’t become functional and started producing hormones. However, if it begins growing rapidly or is very large, it will generally be removed.
• Functioning tumor — surgery may be recommended because it’s producing extra hormones. Medications may be used to prevent the extra hormones from being active or to reduce the hormone level so they don’t produce symptoms. 
• Cancerous tumor, chemotherapy and radiation therapy may be added to the treatment plan.
• Sometimes the entire adrenal gland is removed, requiring hormone replacement therapy after surgery.

Who treats adrenal cancer?

If you’re diagnosed with adrenal cancer, the oncologists (doctors who treat cancer) on your treatment team may include an endocrinologist, surgical oncologist, radiation oncologist, and a medical oncologist, who uses chemotherapy and other medications to treat cancer. 

At Inland Endocrine, we have highly trained specialists who provide the individual care and attention that will speed your recovery. Call today for an appointment with Inland Endocrine’s treatment team.

References

The American Urological Association. N.d. What is an Adrenal Mass? Retrieved 7-6-2021, {https://www.urologyhealth.org/urology-a-z/a_/adrenal-mass

WebMD. 2019. What is an Adrenal Gland Adenoma? Retrieved 7-6-2021, {https://www.webmd.com/cancer/adrenal-gland-adenoma}

Cleveland Clinic. 2018. Adrenal Tumors. Retrieved 7-6-2021, {https://my.clevelandclinic.org/health/diseases/17769-adrenal-tumors}

M.D. Anderson Cancer Center. N.d. Adrenal Tumors. Retrieved 7-6-2-21,

{https://www.mdanderson.org/cancer-types/adrenal-tumors.html}

American Cancer Society. N.d. Treating Adrenal Cancer. Retrieved 7-6-2021, {https://www.cancer.org/cancer/adrenal-cancer/treating.html#:~:text=Who%20treats%20adrenal%20cancer%3F,in%20glands%20that%20secrete%20hormones}