Adrenal Tumors

Adrenal Tumors

Adrenal glands are small glands present at the apex of the kidneys. It is made up of two parts, the cortex (outer part) and medulla (inner part). Adrenal tumors can arise from either of the adrenal gland. These can arise, either from outer layer (cortex) or inner layer (medulla). Tumors arising from medulla are called pheochromocytomas. Tumors arising from cortex can be benign or adrenocortical carcinoma (ACC), which is a malignant tumor.  

Adrenal glands are responsible for hormonal milleu of body by producing three types of hormones – aldosterone, cortisol, and catacholamines. They are responsible for the production of androgens (male reproductive hormones) and estrogens (female reproductive hormones). 

Causes of Adrenal Tumors

The exact cause of adrenal tumors is not known. It may occur due to gene mutations in case of malignant tumors. These mutations can lead to uncontrollable growth resulting in the formation of a tumor. The cancer cells formed can spread to other parts of the body through metastasis (advanced stage).

Symptoms of Adrenal Tumors

Symptoms appear due to increase in levels of hormones produced by the adrenal gland. Common symptoms of adrenal tumors are:

• Excessive growth of facial and pubic hair
• Early puberty in girls
• Enlarged breasts
• Shrinking testicles and loss of sexual desire (libido) in men
• Irregular menstrual periods, excess facial hair in women
• Weight gain
• Muscle weakness
• High BP with palpitations
• Headache

Medical conditions associated with adrenal tumors

Excess secretions of hormones from adrenal gland tumours can lead to conditions such as Cushing syndrome (high levels of cortisol hormone), hyperaldosteronism (high levels of aldosterone), and pheochromocytoma (increased metamorphins).

Diagnosis of Adrenal Tumors

The healthcare provider initially obtains medical history and performs a physical examination. Tests that may be recommended to confirm the diagnosis of adrenal tumors are:

Blood tests are performed to determine complete and differential blood count, and also serum levels of hormones. Urine tests are also performed to measure the amount of adrenal hormones.

Imaging tests: Imaging tests such as computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, and ultrasound can help to determine tumor size and extent of the damage. Positron emission tomography (PET) scan can help to determine the spread of cancer to other organs in case of suspected adrenal cortical carcinoma (ACC).

Biopsy: A small sample of affected tissue is obtained with the help of a fine needle to examine under the microscope. A biopsy can help to identify cancerous cells and the type of carcinoma. Biopsy is not required in majority of cases and contraindicated in case of suspected pheochromocytoma.

Treatments for Adrenal Tumors 

Treatment of adrenal tumors includes surgery, radiation therapy, chemotherapy, and targeted therapy. There is a chance of cure and an increase in survival rate if the condition is diagnosed early. 

Symptomatic therapy can be given initially to relieve symptoms caused by excess production of hormones. 

Surgery: Surgical removal of the adrenal gland is called adrenalectomy. It can be done by conventional open method or minimally invasive approach (laparoscopic or robotic).

Radiation therapy: High energy X-rays are directed towards the target tissue or tumor to kill the cancer cells. It can also be given with chemotherapy if surgery is not an option.

Chemotherapy: Chemotherapy is given to kill circulating cancer cells. This therapy is mostly recommended for patients with advanced stages (in case of spread).

Targeted therapy: It is a therapy that targets proteins controlling growth, division, and spread of cancer cells.

Multidisciplinary team approach (MDT): In case of functional adrenal tumors (likely pheochromocytoma), a MDT approach including surgeon, anesthetist, and endocrinologist would be necessary for better and safer patient outcomes.