The adrenal glands are small, triangular-shaped organs situated atop each kidney. They produce various hormones that regulate metabolism, blood pressure, and stress responses. An adrenal adenoma is a benign, non-cancerous growth that forms on one of these glands.
Understanding Adrenal Adenomas
Adrenal adenomas are categorized as either functional or non-functional. Their significance depends on whether they produce excess hormones. Functional adenomas produce and secrete hormones, leading to symptoms from hormone imbalances.
The most common hormones produced by functional adenomas include cortisol, leading to Cushing’s syndrome, or aldosterone, which causes primary aldosteronism (Conn’s syndrome). In rarer instances, functional adenomas might produce sex hormones. Most adrenal adenomas are non-functional, meaning they do not produce excess hormones. These non-functional adenomas are often discovered incidentally during imaging scans for other medical conditions, earning them the nickname “incidentalomas.”
Recognizing the Signs
Symptoms of an adrenal adenoma vary depending on whether the growth is functional or non-functional. If an adenoma produces too much cortisol, individuals may experience weight gain, particularly in the torso, high blood pressure, muscle weakness, thin skin, fatigue, high blood sugar, and purple stretch marks.
When an adrenal adenoma secretes too much aldosterone, symptoms often include high blood pressure that can be difficult to control and low levels of potassium in the blood. This imbalance can lead to muscle weakness, muscle cramps, and increased thirst or frequent urination. Non-functional adrenal adenomas generally do not cause any symptoms because they do not disrupt hormone levels. Symptoms from a non-functional adenoma are rare and only occur if the growth becomes very large and presses on nearby organs.
Diagnosis and Treatment Approaches
Diagnosing an adrenal adenoma involves imaging studies and laboratory tests. Imaging techniques like computed tomography (CT) scans or magnetic resonance imaging (MRI) of the abdomen identify these growths. These scans help determine the size, shape, and characteristics of the adrenal mass, which can suggest whether it is benign.
Blood and urine tests assess hormone levels, particularly if a functional adenoma is suspected. These tests measure levels of cortisol, aldosterone, and other hormones. Tests like a 24-hour urine collection for cortisol or a plasma aldosterone-to-renin ratio confirm hormonal activity.
Treatment depends on the adenoma’s type and symptoms. For most non-functional adenomas, a watchful waiting approach is common, involving regular follow-up imaging and hormone checks. Functional adenomas require intervention; medications may be prescribed to control hormone levels, such as spironolactone for excess aldosterone or drugs to manage high cortisol. Surgical removal of the affected adrenal gland, known as an adrenalectomy, is recommended for functional adenomas, larger non-functional adenomas (typically over 4 centimeters), or those with suspicious features.
Living with an Adrenal Adenoma
Most adrenal adenomas are benign and do not progress to cancer. For individuals with non-functional adenomas, ongoing monitoring is important, including periodic imaging scans and hormone level checks to ensure the growth remains stable and does not begin producing hormones.
Following an adrenalectomy, recovery time can range from one to two weeks for minimally invasive procedures. Patients who undergo surgery for a functional adenoma often experience a return to normal hormone levels and improvement in associated symptoms. While some individuals might need temporary hormone replacement after surgery, the remaining adrenal gland can usually compensate if only one was removed. The outlook for most people with adrenal adenomas is favorable, particularly with appropriate diagnosis and management.