Adrenal tumors are growths that develop on the small, triangle-shaped glands located above each kidney. These glands are part of the endocrine system, producing hormones like cortisol, aldosterone, and adrenaline that regulate metabolism, blood pressure, and the body’s response to stress. A tumor is often discovered incidentally during an imaging scan, such as a CT or MRI, performed for an unrelated medical issue, in which case it is called an incidentaloma. Treating a tumor requires the coordinated effort of several specialized physicians working as a multidisciplinary team. The treatment path depends heavily on whether the tumor is producing excess hormones and if the growth is benign or malignant.
Endocrinologists: Initial Diagnosis and Hormonal Stabilization
The first specialist to manage an adrenal tumor is typically an endocrinologist, a physician who specializes in disorders of the hormone-producing glands. Their primary role is to determine if the tumor is functional (overproducing hormones) or non-functional (hormonally silent). This distinction is important because a functional tumor poses immediate health risks due to hormone imbalances.
Diagnostic testing involves blood and urine analyses to measure specific hormone levels. A 24-hour urine collection might check for excess cortisol (Cushing’s syndrome) or high levels of catecholamines (pheochromocytoma). For tumors suspected of producing aldosterone, the endocrinologist analyzes the ratio of aldosterone to plasma renin activity (ARR) in the blood.
Interpreting these results and corresponding imaging studies allows the endocrinologist to assess the tumor’s nature and risk. If a tumor is functional, the endocrinologist must medically stabilize the patient before surgery can safely occur. This is especially true for a pheochromocytoma, where uncontrolled release of adrenaline-type hormones during surgery could cause a life-threatening hypertensive crisis.
Hormonal stabilization involves prescribing specific medications, such as alpha and beta-blockers for pheochromocytoma, or drugs like metyrapone or ketoconazole to block cortisol production in Cushing’s syndrome. This pre-operative medical optimization reduces the risk of complications and is a bridge to surgical treatment. The endocrinologist also monitors non-functional tumors that are small and appear benign, recommending repeat imaging in 6 to 12 months, followed by hormonal checks every one to two years for several years.
Surgical Specialists: Tumor Removal
When the decision is made to remove the mass, the case transitions to a specialized surgeon for an adrenalectomy, the removal of the adrenal gland containing the tumor. The two main surgical specialists who perform this procedure are endocrine surgeons and urologists. Endocrine surgeons possess focused training in hormone-producing glands, while urologists are generally skilled in operating on retroperitoneal organs, including the adjacent adrenal glands.
The experience of the surgeon is often considered more important than the specific specialty title, as adrenal surgery is technically demanding and relatively uncommon. High-volume surgeons generally have better patient outcomes and lower complication rates. The surgical approach is customized based on the tumor’s size, location, and potential for malignancy.
The vast majority of adrenal tumors are removed using minimally invasive techniques, such as laparoscopic or robotic surgery, which require only a few small incisions. These approaches allow for a faster recovery and shorter hospital stay compared to traditional open surgery. However, large tumors, typically over 8 to 12 centimeters, or those strongly suspected of being malignant, often require an open adrenalectomy to ensure complete removal and clear margins.
Navigating Malignancy and Long-Term Follow-Up
In the less common scenario where the tumor is diagnosed or highly suspected to be Adrenocortical Carcinoma (ACC), a rare and aggressive cancer, the treatment team expands to include a medical oncologist. The oncologist specializes in systemic treatments, managing chemotherapy and other drug therapies if the cancer has spread or is highly aggressive. The standard treatment for ACC is surgical removal, and the oncologist may recommend adjuvant therapy, such as the drug mitotane, after surgery to reduce the risk of cancer recurrence.
The pathologist plays a discrete but defining role by analyzing the tissue removed during surgery to provide a definitive diagnosis and staging, which guides all subsequent treatment decisions. If the tumor is confirmed to be cancerous, radiation therapy may be considered by a radiation oncologist to treat local recurrence or to manage symptoms from cancer that has spread to other areas.
Regardless of whether the tumor was benign or malignant, long-term follow-up remains a necessity, primarily managed by the endocrinologist. This surveillance focuses on monitoring for tumor recurrence and managing the patient’s hormonal balance, especially if the remaining adrenal tissue is not producing sufficient hormones. Patients require regular physical examinations, blood tests to check hormone levels, and periodic imaging studies to ensure any changes are detected early.