Diagnosing and Treating Adrenal Tumors

The adrenal glands are a pair of small endocrine glands located above the kidneys. They respond to signals from the nervous system and secrete hormones—including cortisol, metanephrines and aldosterone—that regulate stress, help maintain metabolism, and distinguish male and female physical and sexual characteristics.

Most growths on the adrenal glands are not cancerous but may produce hormones that can have an effect on the patient’s blood pressure or response to stress. These benign, functional tumors are very treatable. Adrenal tumors that are malignant (cancer) are rare. These tumors usually grow from a cancer that has metastasized (spread) from a tumor that began in a different organ.

While adrenal tumors can occur in anyone, people with certain genetic conditions are at a higher risk for developing adrenal tumors.

Types of Adrenal Tumors We Treat:

  • Pheochromocytoma, a type of neuroendocrine tumor (made up of both nerve and hormone producing cells), is a rare and usually benign tumor that develops in cells in the center of an adrenal gland. This type of tumor is genetic and runs in families.
  • Adrenocortical carcinoma, a rare disease in which cancer forms in the cortex (outer layer) of an adrenal gland.
  • Cushing's syndrome, excessive cortisol hormone production caused by an adrenal tumor
  • Conn's syndrome, excessive aldosterone production caused by an adrenal tumor.
  • Incidentalomas enlarged adrenal glands that have a risk of being adrenal cancer.

How are Adrenal Tumors Diagnosed?

At MedStar Washington Hospital Center, surgeons use several methods to diagnose an adrenal tumor.

  • Biopsy: Rarely used. A small amount of tissue from the adrenal gland is removed usually with a fine needle to examine it for any evidence of cancer. We reserve this for either patients who have advanced adrenal tumors that appear to be cancer and cannot be removed surgically to make the diagnosis of cancer, or for patients who have cancers in other parts of their body that appear to have spread to the adrenal gland.
  • Blood and urine tests: These tests can show levels of hormones that may signal the presence of a functional adrenal tumor.
  • Imaging: A CT scan or MRI scan can show whether a tumor exists and determine the location and its size.
  • Metaiodobenzylguanidine scan (MIBG): This is a special test that can show adrenal tumors that other imaging tests cannot. It is administered over two days. On the first day, a patient gets an injection of a radioisotope that attaches to tumor cells. This is followed by a scan with a special camera. The next day, the scan is repeated.
  • Adrenal vein sampling: This test can allow us to figure out which of the adrenal glands is overproducing hormone, either in patients with tumors of both glands or with hyperplasia (overgrowth) of the glands that do not clearly have a tumor.

How are Adrenal Tumors Treated?

Treatment is based on where the adrenal tumor is located, its size, whether it is functional and whether or not it is likely to be malignant. For most patients, surgery is the best treatment option. It can be used alone, or in some cases of adrenal cancer, in conjunction with radiation or chemotherapy.

When additional therapies are needed, our endocrine surgical team works collaboratively with other specialists at MedStar Washington Hospital Center to develop a comprehensive treatment plan.

Some patients will be treated with open surgery. This is traditionally used for larger adrenal tumors or tumors that are attached to other nearby organs. It requires larger incisions, usually made through the abdomen.

Our surgeons are particularly skilled at a less invasive surgical procedure that is an option for an increasing number of patients—a laparoscopic adrenalectomy. In this procedure, adrenal tumors are removed through small incisions measuring 1-2 cm along the abdominal wall. This speeds recovery, minimizes scarring, and lowers the risk of injury to abdominal organs. 

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