Adrenal adenomas

Diagnosis

Many people are unaware that they have an adrenal adenoma until an imaging test for another illness by their healthcare provider reveals an adrenal gland tumor. Because they are discovered by accident, these tumors are sometimes referred to as “incidentalomas”.

The healthcare provider will first establish whether a tumor is cancerous (such as adrenocortical carcinoma) or benign (such as an adrenal adenoma). They will run tests to see if the adrenal adenoma is secreting too many hormones if that is the case.

To find out more about the tumor, the healthcare provider may run any of the following tests:

• Physical examination: The healthcare provider will do a physical examination and ask regarding the underlying symptoms and medical background.
• Imaging test: Imaging assists in identifying a tumor’s malignancy or benign. For instance, larger (4 centimeter or larger) tumors are more likely to be malignant than smaller tumors.

The imaging test most frequently used to identify adrenal adenoma is a CT scan. The healthcare provider might request an MRI in specific cases instead.

• Blood or urine test: The healthcare provider can check for high hormone levels by a blood or urine test, which could indicate the presence of a tumor that is functioning. To check for high cortisol, the patient might need to collect their urine for 24 hours.
• Biopsy: If additional testing are insufficient to determine whether a tumor is cancerous or an adrenal adenoma, the healthcare provider may perform a fine-needle aspiration. They will remove tissue from the tumor using a tiny hollow needle during the procedure. A lab expert known as a pathologist looks at the tissue under a microscope to look for indications of malignancy.
• Other tests: This could involve a metaiodobenzylguanidine (MIBG) scan or adrenal vein sampling.

Treatment

Whether the tumor is functional (secreting too many hormones) or nonfunctional will affect the course of treatment. To ensure that a small, non-functioning tumor doesn’t become larger or become functional, the healthcare provider may advise routine CT scans. They may advise surgery if the tumor expands rapidly or becomes larger (often approaching 5 cm). A tumor has a higher chance of developing into cancer if it is large and growing quickly.

Surgery is nearly often used to treat tumors that are still functioning. Treatments include of:

• Adrenalectomy (adrenal gland removal): If the tumor is benign and small, the healthcare provider may do a laparoscopy to remove the adrenal gland. During a laparoscopy, tiny incisions are made in the abdomen, and the surgery is done there. The healthcare provider may perform surgery by creating a wider incision in the back for a larger tumor or one that appears to be cancerous. In some cases, their remaining adrenal gland may produce sufficient amounts of hormones to maintain their health. In some cases, hormone therapy may be required to make up for the missing hormones.
• Medications: The patient’s healthcare provider may recommend medications to stop the adenoma from producing too many hormones if they are not a candidate for surgery. Following an adrenalectomy, they might also be given medication for a few weeks to help regulate their hormone levels.