The adrenal glands, small, triangle-shaped organs located above each kidney, are part of your endocrine system. They produce a variety of hormones, including cortisol, aldosterone, and adrenaline, which regulate metabolism, blood pressure, the immune system, and stress response. An adrenal cyst is a fluid-filled sac that develops on these glands. This article aims to clarify the common concern regarding the seriousness of adrenal cysts.
Understanding Adrenal Cysts
Adrenal cysts are fluid-filled sacs that can form on the adrenal glands. These cysts are considered a relatively rare finding. They can vary considerably in size, from 0.5 cm to 20 cm, with a median size around 4.8 cm.
Adrenal cysts can be broadly categorized into several types based on their characteristics. These include pseudocysts, often resulting from prior hemorrhage, and endothelial cysts, arising from vascular or lymphatic malformations. Other types include epithelial and parasitic cysts.
Are Adrenal Cysts Typically Serious?
Most adrenal cysts are not serious; they are benign, meaning non-cancerous, and do not cause symptoms. A significant majority, approximately 88% of benign adrenal cysts, are discovered incidentally during imaging for unrelated conditions. This incidental discovery is common due to the increased use of diagnostic imaging such as CT scans and ultrasounds.
These harmless cysts include “simple cysts” and “pseudocysts,” which pose no health risks. They are hormonally non-functional, meaning they do not produce excess hormones. Only about 10% of adrenal cysts cause symptoms.
While most adrenal cysts are benign, some malignant adrenal neoplasms can undergo cystic transformation, making differentiation challenging. The likelihood of malignancy in incidentally discovered adrenal masses increases with size, with masses larger than 6 cm having about a 25% risk.
Identifying When a Cyst Requires Medical Attention
Certain characteristics of an adrenal cyst may indicate a need for further medical investigation. The size and growth rate of the cyst are significant factors; cysts that are large, over 5 cm, or those that rapidly increase in size warrant closer evaluation. Large cysts can cause symptoms due to their mass effect, such as abdominal pain or discomfort, or even rupture or bleeding.
Symptoms can also arise if the cyst is causing hormone overproduction, though this is uncommon. Such symptoms might include high blood pressure, palpitations, unexplained weight changes, or muscle weakness, depending on which hormone is affected. Imaging features on scans like CT or MRI also provide important clues. Cysts with solid components, calcifications, irregular borders, or other atypical appearances suggest a need for further assessment. Certain rare types of cysts, such as neoplastic cysts (tumors that can be benign or malignant) or large hemorrhagic cysts, also require more careful evaluation.
Managing Adrenal Cysts
The approach to managing adrenal cysts depends on their characteristics, including size, symptoms, and imaging features. For small, asymptomatic cysts that appear benign on imaging, a common approach is observation. This involves regular monitoring with imaging techniques such as ultrasound, CT, or MRI to track any changes.
If a cyst is suspicious, further diagnostic workup is typically recommended. This may include blood and urine tests to check for any hormone overproduction. Hormonal screening is recommended, as missing an active tumor could have serious consequences.
Surgical removal, known as adrenalectomy, is generally considered for cysts that are symptomatic, very large (typically over 5 cm), or have suspicious features that suggest potential malignancy or hormone production. Laparoscopic adrenalectomy is often the preferred surgical method due to benefits like shorter hospital stays and less blood loss. However, open surgery may be necessary for larger or more complex masses.