An adrenal adenoma is a benign, non-cancerous tumor that develops on one of the adrenal glands, the small hormone-producing organs situated above the kidneys. These growths are frequently discovered incidentally during imaging tests performed for unrelated health concerns. The treatment approach depends almost entirely on the tumor’s functional status—whether it is actively producing excess hormones (functional) or is non-functional. Determining the appropriate medical specialists involves a comprehensive evaluation of the tumor’s physical characteristics and its hormonal output.
The Lead Specialist: The Endocrinologist
The endocrinologist, a physician specializing in hormones and the glands that produce them, serves as the primary medical manager for a patient with an adrenal adenoma. Their initial responsibility is to perform a detailed biochemical workup to classify the tumor as functional or non-functional. This evaluation involves specific blood and urine tests to measure the levels of hormones produced by the adrenal gland, including cortisol, aldosterone, and catecholamines.
To test for autonomous cortisol secretion, the endocrinologist often uses the one-milligram overnight dexamethasone suppression test. This test determines if the adenoma is inappropriately producing cortisol, sometimes known as mild autonomous cortisol secretion. For patients with high blood pressure, a plasma aldosterone-to-renin ratio screens for excess aldosterone, a condition known as primary aldosteronism.
If the adenoma is non-functional and small, the endocrinologist generally recommends watchful waiting, also known as active surveillance. This long-term monitoring involves periodic follow-up appointments with repeat hormone testing and imaging to ensure the tumor remains stable in size and does not begin producing hormones. For functional adenomas that are not immediate surgical candidates, the endocrinologist manages medical treatment, such as prescribing medications to block the effects of excess aldosterone.
The endocrinologist also plays a continuing role in managing the metabolic consequences of hormone excess, even after surgery. Excess cortisol, for example, can lead to conditions like diabetes and hypertension, which require ongoing medical management. This specialist leads the strategy to mitigate these systemic health risks and stabilize the patient’s overall hormonal and metabolic health.
The Role of the Adrenal Surgeon
The adrenal surgeon becomes the lead specialist when the adenoma meets specific criteria indicating a need for surgical removal, a procedure called adrenalectomy. Surgery is primarily required for any functional adenoma causing a significant hormonal imbalance, regardless of its size. Removing the source of hormone overproduction is often the most definitive treatment for conditions like primary aldosteronism or overt Cushing’s syndrome.
Surgery is also considered for non-functional adenomas that pose a risk of malignancy. Guidelines suggest considering surgical removal for tumors larger than four centimeters, as the likelihood of a cancerous growth (adrenocortical carcinoma) increases with size. Furthermore, any non-functional tumor that shows significant growth during surveillance may also be flagged for surgical resection due to increased suspicion of malignancy.
The adrenalectomy procedure is usually performed by a specialized surgical sub-group, which includes Endocrine Surgeons, Urologic Surgeons, or General Surgeons with specialized experience. The preferred technique is often a minimally invasive approach, such as laparoscopic or retroperitoneoscopic surgery, which involves making small incisions. This technique typically results in less pain, shorter hospital stays, and a quicker recovery compared to traditional open surgery.
The surgeon works closely with the endocrinologist pre-operatively, especially for tumors producing catecholamines, to ensure the patient is medically stabilized before the operation. This collaboration minimizes the risk of complications, such as a hypertensive crisis, during tumor removal. After the adrenal gland is removed, the patient returns to the endocrinologist for post-operative hormonal management and monitoring.
Supporting Roles in Diagnosis and Monitoring
While the endocrinologist and surgeon lead treatment, several other specialists provide foundational support in the diagnosis and monitoring of an adrenal adenoma. The Primary Care Physician (PCP) often initiates the process, as they typically first encounter the adenoma. This discovery frequently occurs when a patient undergoes a computed tomography (CT) or magnetic resonance imaging (MRI) scan for an unrelated abdominal or chest complaint.
The Radiologist is essential for characterizing the tumor based on imaging studies. They interpret CT or MRI scans, providing details about the adenoma’s size, shape, and internal composition. Benign adrenal adenomas often have a specific appearance on non-contrast CT, typically showing a low Hounsfield Unit (HU) measurement, which helps distinguish them from more concerning masses. The radiologist’s report prompts the PCP to refer the patient to an endocrinologist for the hormonal workup.
Finally, the Pathologist plays a role following surgical removal of the tumor. Once the adrenal gland is removed, the pathologist analyzes the tissue under a microscope. Their analysis confirms the benign nature of the adenoma and definitively rules out malignancy, providing the final and most accurate diagnosis. This confirmation is important for determining the patient’s long-term prognosis and follow-up schedule.