The adrenal glands, small, triangular-shaped organs, sit atop each kidney. These glands are part of the endocrine system, producing hormones that regulate metabolism, blood pressure, and the body’s stress response. Growths can sometimes form on these glands, known as adrenal tumors. Their potential to be cancerous is a common concern.
Benign and Malignant Adrenal Tumors
Over 95% of adrenal tumors are benign. The risk of an adrenal tumor being cancerous is low, often less than 3%. Benign and malignant tumors differ in behavior. Benign tumors typically do not spread, and their growth is usually contained. Malignant tumors, in contrast, can invade surrounding tissues and spread to distant organs (metastasis), impacting prognosis and treatment.
Specific Types of Adrenal Tumors
Adrenocortical adenomas are the most common type of benign adrenal tumor, originating in the outer layer. Many are non-functional, not producing excess hormones, and often cause no symptoms. However, some benign adenomas can be functional, leading to overproduction of hormones like cortisol or aldosterone.
Adrenocortical carcinoma (ACC) is the most prevalent type of adrenal cancer, though rare (1-2 cases per million annually). Pheochromocytomas originate in the inner adrenal gland, producing stress hormones (catecholamines). While most pheochromocytomas are benign, approximately 10% to 15% can be malignant. Metastatic tumors, spread from other primary sites like the lungs, breasts, or kidneys, are another malignant adrenal growth.
Diagnosing Adrenal Tumors
Adrenal tumors are frequently discovered incidentally during imaging scans for unrelated conditions, termed “adrenal incidentalomas.” Their prevalence ranges from 1.4% to 7.3% in adults, increasing with age. Once an adrenal mass is identified, a thorough evaluation is necessary.
Diagnosis involves imaging and hormone tests. CT scans are often initial, providing detailed information about tumor size, shape, and density. MRI or PET scans may be used for further characterization or to assess for spread. Blood and urine tests check for abnormal hormone levels, indicating whether the tumor is functional. Hormonal assessments, like 24-hour urine collections for cortisol or aldosterone, are important for diagnosis and management.
What Happens After Diagnosis
Management depends on the tumor’s type, size, and hormone production. For benign, non-functional tumors, a “watchful waiting” approach is often adopted. This involves regular monitoring with imaging and hormone tests to track changes.
If a benign tumor is functional, medical management may control hormone levels, and surgical removal (adrenalectomy) is often recommended. For malignant tumors like adrenocortical carcinoma, surgery to remove the affected adrenal gland is the primary treatment. Depending on characteristics and stage, additional treatments like chemotherapy or radiation may be considered. A multidisciplinary team often collaborates to develop a treatment strategy.