Adrenal tumors are common. Studies estimate that around 3% of all adults have a tumor in the adrenal gland. The older you are, the more common adrenal tumors can be. Many people do not know they have an adrenal tumor. The majority of adrenal tumors are not critical because they are benign. However, if a tumor shows a size of more than 1 cm in diameter or if symptoms arise, for example, due to hormone overproduction, affected persons should talk to an endocrinologist as soon as possible.
What are adrenal tumors?
In Cushing’s syndrome, too much cortisol is produced. The result is bone pain, muscle atrophy, osteoporosis, diabetes, high blood pressure, acne, frequent infections, profuse sweating, psychosis or growth disorders. Another symptom is uncontrolled weight gain. Patients suffer from a strong increase of the belly (“beer belly”), in contrast, arms and legs are very slim. A very round face, colloquially known as moon face or full moon face, is also a typical symptom of Cushing’s syndrome. The fat storage in the face, which is responsible for the optically round shape, additionally leads to a strong reddening of the facial skin.
Conn syndrome
In Conn syndrome, the hormone aldosterone is produced. This influences the water balance in the kidney. It causes potassium to be excreted more, decreases the amount of water excretion overall, and has an increasing effect on blood pressure. Symptoms include permanently elevated blood pressure, headaches, dizziness and muscle weakness. Excessive thirst is also among the symptoms.
Pheochromocytoma
Pheochromocytoma is usually benign. The tumor causes an overproduction of epinephrine and norepinephrine. Associated symptoms include either permanent or transient hypertension, headache, dizziness, profuse sweating/sweating, palpitations and arrhythmias, tremors, diabetes mellitus, weight gain, nervousness, anxiety, and angina. In particular, the combination of headache, palpitations, and sweating, as well as hypertension that cannot be controlled with medication, represent severe symptoms that should prompt investigation for an adrenal tumor.
Adrenocortical carcinoma
Adrenocortical carcinoma can cause all the symptoms that hormone overproduction entails. Patients may suffer from any of the symptoms of Cushing’s syndrome or excess sex hormones. Heavy body hair or balding, deep voice in women or breast growth in men, and bloating and pain around the kidney also occur.
Diagnosis
Diseased adrenal glands entail typical physical impairments and pathological changes. During functional diagnostics, the hormone level of the adrenal glands is determined. Blood is taken for this purpose. The concentration of blood salts is measured. The same is examined in a urine sample. The examinations provide information as to whether hormone overproduction is taking place. Two tests are used for precise clarification: the CRH test and the desamethasone inhibition test. Further diagnosis is made with a computer tomography, which detects adrenal tumors as small as 5 mm in diameter. It is highly effective at a diameter of 2 cm. Ultrasound examinations detect tumors larger than 2 cm. The examination method of magnetic resonance imaging is indicated in the diagnosis of pheochromocytomas, as is scintigraphy. Selective blood sampling from the adrenal vein is used to determine whether there is an overproduction of hormones.
When should you see a doctor?
Adrenal tumors are usually discovered more by chance, for example, during ultrasound or other imaging procedures. Symptoms may also point to these tumors: If headaches, palpitations, and sweating are present over a long period of time, as well as blood pressure that cannot be adjusted, affected individuals should first see their established family physician. Other symptoms of an adrenal tumor may include a constant feeling of fullness, kidney pain, sudden increases in weight, palpitations and cardiac arrhythmias, as well as headaches, nausea, dizziness or anxiety. A general practitioner can perform the initial tests here and refer the patient to an endocrinologist in the next step.The diagnosis of the type of tumor and further treatment must be carried out by a specialist. The therapy depends on the tumor identified. Therapeutic concepts are often broad and cannot be reduced to one or two therapeutic approaches.
- Patients with an advanced-stage tumor are treated with chemotherapy or receive local radiation.
- In the case of hormone excess syndrome, surgery may be performed to reduce the tumor mass. On this basis, the chances of any subsequent chemotherapy are improved.
- Radiation of metastases is also a possible therapeutic approach.
- A number of drugs attack the adrenal tumors. Endocrinological protective monitoring is scheduled as part of therapy. This involves checking the levels of ACTH, cortisol and DHEAS.
- Glucocorticoid therapy against active residual tumors is also indicated.
Outlook and prognosis
If adrenal tumors are found exclusively in the kidney, the five-year survival rate is over 70%. The smaller a tumor is, the higher the prospects for cure. The survival rate in the early stage is 90%. The more advanced a tumor is, the lower the prospects of cure and life expectancy. From stage IV (final stage) onwards, there is generally no longer any chance of a cure. At this point, life expectancy is about one year without treatment and two years with chemotherapy.
Follow-up care
Follow-up care is coordinated between the primary care physician/internist, clinic, and endocrinologist. If surgery is performed, the skin sutures are pulled after 10 days. This is followed by follow-up therapy as needed, such as radiation. If patients are tumor-free, regular follow-up examinations are due to determine the further procedure on an individual basis.
