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Adrenal adenomas are non-cancerous tumors that develop in the adrenal glands. This is the most common kind of adrenal gland tumor. The endocrine system includes the adrenal gland, they release hormones that aid the body’s reaction to stress. In addition to other essential functions, the adrenal glands also release hormones that control the immune system, blood sugar, and blood pressure.
The body have two adrenal glands, which is situated above the kidney. Cortex and medulla make up the two different tissue types found in the gland. The term “adrenal adenomas” also refers to benign adrenal tumors that form in the cortex. Pheochromocytomas are another name for those that form in the medulla.
Adrenal adenomas can either be functional or nonfunctional. Both tumor types have a low chance of developing into cancer, but an adrenal adenoma that is inactive can become active.
- Functioning (active) adrenal adenomas: This can release too many hormones from the adrenal glands, which can lead to symptoms that need to be treated.
- Nonfunctioning (inactive) adrenal adenomas: There are no extra adrenal hormones produced by this. The majority of adrenal adenomas do not function. They don’t produce symptoms or need care.
The majority of benign adrenal masses are asymptomatic and do not require treatment. However, these tumors occasionally release too much hormones, which can lead to problems.
Aldosterone and cortisol from the cortex and adrenalin hormones from the medulla are the hormones most frequently found to be over-secreted. Surgery or medication may be used in certain situations as benign adrenal tumor treatment.
Symptoms
The symptoms of excess hormones in the body, particularly excess cortisol (Cushing’s syndrome) or excess aldosterone (primary aldosteronism), may be brought on by functioning adrenal adenomas. Signs and symptoms may include:
- Headache.
- Muscle weakness or numbness.
- Fatigue
- Back pain
- Hypertension (high blood pressure)
- Diabetes
- Hypokalemia (low potassium level)
- Abdominal stretch marks.
- Upper body weight gain.
- Mood swing (anxiety, panic or depression).
Individuals assigned female at birth (AFAB) may encounter irregular menstrual cycles and an increase of masculine traits (virilization). Individuals assigned male at birth (AMAB) may have sexual dysfunction.
Cause
Researchers don’t know what causes an adrenal adenoma or other benign adrenal gland tumors to form. Still, certain genetic conditions may increase your risk, including:
- Multiple endocrine neoplasia, type 1 (MEN1).
- Multiple endocrine neoplasia type 2 (MEN2).
- Familial adenomatous polyposis (FAP)
- Li-Fraumeni syndrome
- Carney complex.
- Neurofibromatosis Type 1
The likelihood of getting an adrenal adenoma may also be increased by obesity and tobacco use.
Risk factors
An adrenal adenoma can affect anyone, however the probability rises with age. Adrenal adenomas affect 3% to 9% of the population. They are the most typical kind of tumor in the adrenal gland.
Diagnosis
Many people are unaware that they have an adrenal adenoma until an imaging test for another illness by their healthcare provider reveals an adrenal gland tumor. Because they are discovered by accident, these tumors are sometimes referred to as “incidentalomas”.
The healthcare provider will first establish whether a tumor is cancerous (such as adrenocortical carcinoma) or benign (such as an adrenal adenoma). They will run tests to see if the adrenal adenoma is secreting too many hormones if that is the case.
To find out more about the tumor, the healthcare provider may run any of the following tests:
- Physical examination: The healthcare provider will do a physical examination and ask regarding the underlying symptoms and medical background.
- Imaging test: Imaging assists in identifying a tumor’s malignancy or benign. For instance, larger (4 centimeter or larger) tumors are more likely to be malignant than smaller tumors.
The imaging test most frequently used to identify adrenal adenoma is a CT scan. The healthcare provider might request an MRI in specific cases instead.
- Blood or urine test: The healthcare provider can check for high hormone levels by a blood or urine test, which could indicate the presence of a tumor that is functioning. To check for high cortisol, the patient might need to collect their urine for 24 hours.
- Biopsy: If additional testing are insufficient to determine whether a tumor is cancerous or an adrenal adenoma, the healthcare provider may perform a fine-needle aspiration. They will remove tissue from the tumor using a tiny hollow needle during the procedure. A lab expert known as a pathologist looks at the tissue under a microscope to look for indications of malignancy.
- Other tests: This could involve a metaiodobenzylguanidine (MIBG) scan or adrenal vein sampling.
Treatment
Whether the tumor is functional (secreting too many hormones) or nonfunctional will affect the course of treatment. To ensure that a small, non-functioning tumor doesn’t become larger or become functional, the healthcare provider may advise routine CT scans. They may advise surgery if the tumor expands rapidly or becomes larger (often approaching 5 cm). A tumor has a higher chance of developing into cancer if it is large and growing quickly.
Surgery is nearly often used to treat tumors that are still functioning. Treatments include of:
- Adrenalectomy (adrenal gland removal): If the tumor is benign and small, the healthcare provider may do a laparoscopy to remove the adrenal gland. During a laparoscopy, tiny incisions are made in the abdomen, and the surgery is done there. The healthcare provider may perform surgery by creating a wider incision in the back for a larger tumor or one that appears to be cancerous. In some cases, their remaining adrenal gland may produce sufficient amounts of hormones to maintain their health. In some cases, hormone therapy may be required to make up for the missing hormones.
- Medications: The patient’s healthcare provider may recommend medications to stop the adenoma from producing too many hormones if they are not a candidate for surgery. Following an adrenalectomy, they might also be given medication for a few weeks to help regulate their hormone levels.
