Adrenal gland tumors: a modern approach to diagnosis and treatment

The adrenal glands produce more than fifty different hormones necessary for the normal functioning of the body. Neoplasms in the adrenal glands are often discovered accidentally during examinations for completely different reasons, such as computed tomography of the abdominal cavity or ultrasound examination of the kidneys.

According to statistics, most neoplasms are benign and do not pose an immediate threat to life. However, each case requires careful evaluation by a specialist.

What is an adrenal gland tumor and why does it occur?

The adrenal glands are small glands that are involved in regulating metabolism, blood pressure, and the body's response to stress. When cells begin to divide uncontrollably or atypical structures appear in the tissue, a neoplasm forms.

An adrenal tumor can occur for various reasons: genetic predisposition, chronic stress, metabolic disorders, and the influence of adverse environmental factors.

The peculiarity of adrenal tumors is that they can exist asymptomatically for years. The size of the adrenal glands normally does not exceed a few centimeters, and a small formation simply does not cause noticeable changes in the body's functioning. A person continues to live a normal life, unaware of the problem, until a random examination reveals changes in the images.

What types of adrenal tumors are there?

When distinguishing adrenal tumors, the classification is based on two key criteria: hormonal activity and growth pattern.

Hormonally active formations produce excessive amounts of one or more hormones. For example, adrenal adenoma, which produces cortisol, causes Cushing's syndrome.

Hormonally inactive neoplasms do not affect blood hormone levels. Such formations can be cystic cavities filled with fluid or dense nodules of various cell types. An adrenal cyst usually does not cause concern if it is small and there are no signs of bleeding into the cavity.

Benign adrenal tumors account for the vast majority of detected neoplasms. They grow slowly, have clear boundaries, and do not spread to neighboring tissues.

Malignant tumors are much less common. Adrenocortical carcinoma is an aggressive tumor that grows rapidly and can metastasize to other organs. Metastases in the adrenal glands are possible in lung, kidney, and breast cancer.

Understanding the difference between the types of neoplasms influences the choice of treatment tactics.

A small, hormonally inactive adenoma may only require observation, while a tumor of the right adrenal gland with signs of hormonal activity requires prompt intervention.

Adrenal gland tumors symptoms

The symptoms of adrenal gland disease depend on whether the tumor produces hormones and, if so, which ones.

Hormonally inactive tumors often go unnoticed for a long time. A person may only experience nonspecific discomfort in the lumbar region, which can easily be confused with spinal or kidney problems. Enlarged adrenal glands sometimes cause a feeling of pressure in the abdomen or pain in the side.

The situation is completely different with hormonally active formations. With excess cortisol production, a characteristic set of symptoms develops:

• rounded contours
• purple stripes on the abdomen, thighs, and shoulders
• the skin becomes thin and easily injured
• weight gain in the torso area
• muscle weakness
• high blood pressure
• menstrual cycle disorders in women

Pheochromocytoma is accompanied by sudden attacks of palpitations, sweating, headaches, and hand tremors. Blood pressure can jump to critical levels.

An excess of aldosterone leads to Conn's syndrome. The main symptoms are related to water and electrolyte imbalance: persistent high blood pressure, muscle weakness due to potassium loss, cramps, and thirst.

When should you have your adrenal glands checked?

Problems with the adrenal glands do not always manifest themselves with pronounced symptoms. However, you should get tested if you notice the following suspicious symptoms:

• Arterial hypertension at a young age (under 40). If your blood pressure rises above 180/110 mm Hg and is poorly controlled with three or more medications.
• Unexpected weight gain or loss without obvious causes.
• Persistent fatigue that does not go away after rest, decreased performance, and depressive states may signal a disruption in adrenal gland function.
• Menstrual cycle disorders.
• Hair growth in unusual places (face, chest).
• Deepening of the voice.

If an ultrasound examination of the abdominal cavity or a CT scan accidentally reveals a neoplasm, further examination is necessary, even if there are no complaints.

If the patient has cancer, adrenal gland examination is often prescribed during staging to rule out metastatic lesions.

How adrenal gland tumors are diagnosed: modern methods

Modern aspects of adrenal gland tumor diagnosis involve a comprehensive approach, combining laboratory and instrumental methods.

The first stage is to determine hormonal status. Blood and urine tests reveal excess production of cortisol, aldosterone, and catecholamines.

Determining the level of aldosterone and renin in the blood reveals primary hyperaldosteronism. Metanephrines in daily urine or plasma are markers of pheochromocytoma.

Contrast-enhanced computed tomography shows the size of the tumor, its density, and the nature of its accumulation.

When evaluating the results of an ultrasound of the adrenal glands, the norm is the absence of visible neoplasms, but ultrasound examination cannot always detect small changes due to the anatomical features of the organ's location.

MRI provides additional information about the structure of the tissue, which is especially useful when pheochromocytoma is suspected or when it is necessary to assess the extent of the malignant process.

Positron emission tomography is used in complex diagnostic cases or in oncological diseases to detect metastases.

Adrenal biopsy is rarely performed, only in specific situations, as it carries a risk of complications and does not always provide a clear answer.

What not to do when an adrenal tumor is detected

First, do not panic. The detection of a neoplasm does not automatically mean the presence of cancer or the need for urgent surgery. Do not prescribe yourself an examination, do not look for ways to “resorb” the tumor on the Internet.

Do not ignore the problem. Even if the tumor is small and asymptomatic, dynamic observation is necessary. Some growths may increase in size or change in nature over time.

Self-medication with hormonal drugs is strictly prohibited—it can interfere with the natural functioning of the adrenal glands and complicate further diagnosis.

How are adrenal tumors treated?

The choice of treatment is influenced by: the size and nature of the formation, hormonal activity, age, and the general condition of the patient.

Small, hormonally inactive tumors with a diameter of up to 3-4 cm often only require observation. The patient is scheduled for follow-up examinations in 3-6 months, then annually, to monitor the growth dynamics.

If the adrenal adenoma remains stable and does not begin to produce hormones, surgical intervention is not necessary.

Medication is used as preparation for surgery or in situations where surgical treatment is not possible. In cases of hypercortisolism, drugs that block cortisol synthesis are prescribed. Patients with pheochromocytoma require special preparation with alpha and beta blockers before surgery to stabilize blood pressure and prevent hypertensive crises during the procedure.

For adrenal adenoma, surgical treatment is indicated in cases of hormonal activity, large size (over 4 cm), rapid growth, or suspected malignancy. Removal of adrenal adenoma is often performed laparoscopically through small punctures in the abdominal wall.

To treat adrenal adenoma, surgery requires a surgeon with experience and high qualifications.

Radiation therapy is used less often, mainly for inoperable tumors or to control metastases. After surgical removal of the neoplasm, radiation therapy may be prescribed as adjuvant treatment to destroy any residual cancer cells in the bed of the removed formation. This is relevant if clean resection margins could not be achieved during surgery. For radiation therapy treatment, make an appointment with a specialist at the Oncare Medical Center.

Modern stereotactic radiotherapy techniques allow high doses of radiation to be precisely targeted at the tumor, minimizing the impact on healthy liver, kidney, and gastrointestinal tract tissues.

Chemotherapy is prescribed for adrenocortical cancer or metastatic forms of the disease.

When is surgery for an adrenal cyst necessary?

What is an adrenal adenoma? It is a dense neoplasm of glandular tissue. A cyst is a cavity filled with fluid.

Surgery for an adrenal cyst is necessary in several situations:

• the formation reaches 5 cm or more, increasing the risk of rupture with bleeding into the abdominal cavity
• a symptomatic cyst that causes pain, compresses adjacent organs, or disrupts urine flow from the kidney
• bleeding inside the cyst or its infection.

Recovery and follow-up after treatment

After laparoscopic removal of an adrenal adenoma, discharge home is possible in 2-4 days. Return to normal activity occurs within 2-3 weeks, and to intense physical activity - in 4-6 weeks.

If a hormonally active formation has been removed, a period of adaptation may be necessary. In Cushing's syndrome, restoration of adrenal function takes from several months to a year.

Follow-up care after treatment includes consultations with an endocrinologist, monitoring of hormone levels, and examinations to rule out recurrence. The prognosis for benign tumors is usually favorable.

Malignant tumors require long-term follow-up with regular examinations to detect possible recurrence or metastasis.

Prevention and early detection of tumors

There is no specific prevention for adrenal tumors, as the exact causes of their occurrence have not yet been established. However, you can reduce your cancer risk by following a healthy lifestyle: a balanced diet, physical activity, quitting smoking, limiting alcohol consumption, and managing stress.

Preventive ultrasound examinations of the abdominal cavity, performed for other reasons, can also be a means of early diagnosis.

Conclusion

Adrenal tumors are a group of various neoplasms. Most of them are benign and may not require active treatment, but all require examination by a specialist.

The success of treatment depends on timely consultation with a doctor, a complete examination, and adherence to recommendations.