ConditionHormones & metabolism
Adrenal Tumors
Adrenal tumors are growths in the adrenal glands, the small glands on top of each kidney that make cortisol, aldosterone and adrenaline. Most are benign adenomas found by chance on a CT or MRI done for another reason. Some produce too much hormone, causing high blood pressure, weight gain, low potassium or episodes of pounding headaches and sweating. A few are cancerous. Every adrenal tumor needs hormone testing and imaging review to decide whether it can be watched or should be removed.
Also called: Adrenal mass, adrenal nodule, adrenal incidentaloma, adrenal adenoma, adrenal growth
At a glance
- What they are
- Growths in one or both adrenal glands, ranging from harmless adenomas to rare cancers.
- How common
- Found on a few percent of abdominal CT scans, more often with age.
- Hormone-producing types
- Cortisol (Cushing syndrome), aldosterone (Conn syndrome), adrenaline (pheochromocytoma).
- Cancer clues
- Size over 4 cm, irregular appearance, rapid growth, or high density on CT.
- Diagnosis
- Blood and urine hormone tests plus CT or MRI characteristics.
- Treatment
- Monitoring for small non-functioning adenomas; surgery (usually laparoscopic adrenalectomy) for hormone-producing or suspicious tumors.
When to get help
Call 911 or go to the ER
- Sudden severe headache, pounding heart, sweating, chest pain and very high blood pressure, especially in someone with a known adrenal mass
- After adrenal surgery: extreme weakness, vomiting, confusion, low blood pressure or severe belly pain (possible adrenal crisis)
See a doctor within a day or two
- Episodes of pounding heartbeat, sweating, headache and paleness, with high blood pressure
- Very low potassium with muscle weakness or cramps
- Rapidly increasing belly pain, fullness or weight loss with a known adrenal mass
Book a routine appointment
- An adrenal "incidentaloma" reported on a scan: arrange hormone testing and follow-up
- High blood pressure that is hard to control on 3 or more medicines, or that started young
- Weight gain in the face and belly with thin skin, purple stretch marks, easy bruising and muscle weakness
What the adrenal glands do
Each adrenal gland has two parts:
- The cortex (outer layer) makes cortisol (stress hormone, blood sugar and blood pressure), aldosterone (salt and water balance) and small amounts of androgens.
- The medulla (inner core) makes adrenaline and noradrenaline (the fight-or-flight hormones).
Tumors can arise from either part, and the type determines the symptoms.
Types of adrenal tumors
| Type | Origin | Hormones | Usual behavior |
|---|---|---|---|
| Adrenal adenoma | Cortex | Usually none; some make cortisol or aldosterone | Benign |
| Aldosterone-producing adenoma | Cortex | Aldosterone | Benign; causes high blood pressure |
| Pheochromocytoma | Medulla | Adrenaline, noradrenaline | About 1 in 10 metastasize |
| Adrenocortical carcinoma | Cortex | Often cortisol or androgens | Rare, aggressive cancer |
| Adrenal metastases | Spread from lung, kidney, breast, melanoma | None | Reflect cancer elsewhere |
| Myelolipoma, cyst | Various | None | Benign |
| Neuroblastoma | Nerve cells, in children | Catecholamines | Childhood cancer |
Symptoms
Most adrenal tumors cause no symptoms and are found by chance. When symptoms occur, they come from hormone excess or, for large tumors, from pressure.
Excess cortisol (Cushing syndrome)
Cushing syndrome causes weight gain in the face, upper back and belly, thin skin that bruises easily, wide purple stretch marks, muscle weakness, high blood pressure, high blood sugar and bone thinning. Many adenomas make slightly too much cortisol without the full picture ("mild autonomous cortisol secretion"), which still raises cardiovascular risk.
Excess aldosterone (primary aldosteronism)
Hyperaldosteronism causes high blood pressure, often resistant to treatment, and sometimes low potassium with muscle weakness, cramps, tiredness and frequent urination. It is one of the most common curable causes of high blood pressure and is underdiagnosed.
Excess adrenaline (pheochromocytoma)
Episodes of pounding headache, sweating and a racing heart, sometimes with anxiety, tremor and paleness, with high blood pressure during or between attacks.
Excess androgens
Acne, excess hair growth, deepening voice and irregular periods in women. Strongly suggests adrenocortical carcinoma.
Large tumors
Fullness or pain in the belly or back, weight loss and fatigue.
Diagnosis
Hormone testing
Recommended for every adrenal mass:
- 1 mg overnight dexamethasone suppression test to screen for excess cortisol
- plasma or urine metanephrines to screen for pheochromocytoma
- aldosterone-to-renin ratio in anyone with high blood pressure or low potassium
- sex hormones and steroid precursors if cancer is suspected
Imaging
- CT scan without contrast: a tumor with low density (10 Hounsfield units or less), smooth edges and size under 4 cm is almost certainly a benign adenoma.
- Contrast washout CT or MRI for indeterminate lesions.
- FDG-PET in some cases.
Biopsy is rarely used, and never before pheochromocytoma has been excluded, because it can trigger a dangerous blood pressure surge.
Treatment
- Small, benign-looking, non-functioning adenomas: usually need no treatment. Current guidelines often recommend no further imaging if the first CT clearly shows a benign adenoma under 4 cm.
- Hormone-producing tumors: surgical removal (adrenalectomy), usually by keyhole (laparoscopic or robotic) surgery with a 1 to 2 night hospital stay. Aldosteronism affecting both glands is treated with medicines such as spironolactone or eplerenone.
- Pheochromocytoma: alpha-blocker medicine for 1 to 2 weeks before surgery to control blood pressure, then removal.
- Suspected or confirmed cancer: open surgery at a specialist center, sometimes followed by mitotane, chemotherapy or radiotherapy.
- After removing a cortisol-producing tumor: steroid replacement for months while the other gland recovers.
Outlook
Benign adenomas rarely cause problems. Removing a hormone-producing tumor often cures or improves high blood pressure, diabetes and other effects. Pheochromocytoma needs lifelong follow-up and genetic testing, because many are inherited. Adrenocortical carcinoma is rare but serious; outlook is best when caught early and completely removed.
Frequently asked questions
Are adrenal tumors usually cancerous?
No. The large majority are benign adenomas, especially small ones found by chance. Cancer is more likely in tumors larger than 4 cm, with irregular features or rapid growth, or in people with a history of cancer elsewhere.
What are the symptoms of an adrenal tumor?
Most cause no symptoms. Hormone-producing tumors can cause high blood pressure, low potassium and muscle weakness, Cushing features such as weight gain and stretch marks, or episodes of headache, sweating and racing heart. Large tumors can cause belly or back pain.
What is an adrenal incidentaloma?
It is an adrenal mass discovered by chance on a scan done for another reason. Guidelines recommend hormone testing for all incidentalomas and imaging review to judge whether it is benign. Most need no treatment.
Do adrenal tumors need to be removed?
Only some. Tumors that produce excess hormones, look suspicious for cancer or are growing are usually removed. Small, benign-looking, non-functioning adenomas can be safely left alone.
Sources
This guide was written from current patient and clinical guidance, including:
- Endocrine Society and European Society of Endocrinology: Clinical Practice Guideline on the Management of Adrenal Incidentalomas (2023)
- Endocrine Society: Primary Aldosteronism Clinical Practice Guideline
- National Cancer Institute: Adrenocortical Carcinoma Treatment (PDQ)
- MedlinePlus: Adrenal gland cancer
- American Association of Endocrine Surgeons: Adrenal patient education