Types of Adrenal Tumors

The adrenal glands are two small, triangular organs located just above the kidneys. As part of the endocrine system, these hormone-producing glands play an essential role in regulating the body’s blood pressure, metabolism, sexual development and response to stress.

If an abnormal mass forms in an adrenal gland, it can interfere with normal hormone production and cause a wide range of symptoms. Some adrenal tumors are benign (noncancerous), while others are cancerous. Because each type of adrenal tumor may behave differently, an early and accurate diagnosis and appropriate treatment are important for protecting overall health.

The types of adrenal tumors include:

Adenomas

Adenomas are the most common type of adrenal tumor. Sometimes referred to as incidentalomas, these benign growths are often discovered by chance during an imaging test performed for an unrelated reason.

Most adrenal adenomas are nonfunctioning, which means they do not produce hormones, cause symptoms or require treatment. However, functioning adrenal adenomas secrete excess hormones, which can lead to hormonal imbalances in the body.

What causes adrenal adenomas?

Scientists have not yet determined exactly what causes adenomas and other benign growths to form in the adrenal glands. However, certain genetic conditions may increase the risk. These include:

• Carney complex
• Familial adenomatous polyposis (FAP)
• Li-Fraumeni syndrome
• Multiple endocrine neoplasia type 1 (MEN1)
• Multiple endocrine neoplasia type 2 (MEN2)
• Neurofibromatosis type 1 (NF1)

Certain lifestyle factors, such as tobacco use and obesity, may also contribute to the development of adrenal adenomas.

What are the symptoms of adrenal adenomas?

Typically, nonfunctioning adenomas do not cause symptoms, but functioning adenomas can disrupt hormone levels, potentially leading to noticeable changes within the body, such as:

• Fatigue, body aches and muscle weakness
• Headaches
• High blood pressure that is difficult to control
• Irregular menstrual cycles and increased masculine characteristics, such as voice deepening, in women
• Sexual dysfunction in men
• Unexplained weight gain, particularly in the upper body

How are adrenal adenomas diagnosed?

After reviewing the symptoms and performing a physical examination, the physician may order diagnostic testing, such as:

• Lab work – A blood or urine test may reveal elevated hormone levels that could be a sign of a functioning tumor. For example, a 24-hour urine collection can be tested for high cortisol.
• Imaging – Computed tomography (CT) is the most commonly used imaging technique for diagnosing adrenal adenomas, although magnetic resonance imaging (MRI) is sometimes used instead. Imaging can help the physician determine whether a tumor is malignant or benign. For example, a large tumor (more than 4 centimeters in diameter) is more likely to be cancerous than a smaller tumor.
• Biopsy – If further information about the tumor is needed, the physician may perform a fine-needle aspiration. During this procedure, the physician will use a thin, hollow needle to remove a small sample of tumor tissue. The specimen will be sent to a lab for microscopic examination by a pathologist.

How are adrenal adenomas treated?

The optimal treatment approach for an adrenal adenoma can vary depending on the size of the tumor and whether it is functioning. Options may include:

• Monitoring with periodic imaging scans for a small, nonfunctioning adenoma
• Surgery (adrenalectomy) to remove a large or functioning adenoma
• Medication to manage hormone-related symptoms

Adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is a rare but aggressive cancer that develops in the outer layer of the adrenal gland (adrenal cortex). The adrenal cortex produces essential hormones, including mineralocorticoids such as aldosterone, which regulate sodium and potassium levels and help maintain fluid and electrolyte balance. Because ACC often grows rapidly and can spread to other parts of the body, early detection and treatment are especially important.

What causes adrenocortical carcinoma?

The exact cause of ACC is not always clear. Some cases are linked to an inherited genetic condition, such as Li-Fraumeni syndrome or Beckwith-Wiedemann syndrome.

What are the symptoms of adrenocortical carcinoma?

As the tumor grows, it may begin to press on nearby organs and tissues. Additionally, a functioning ACC tumor may cause hormone-related changes. Symptoms may include:

• Abdominal or back pain
• An abdominal mass or sense of fullness
• Unintended weight loss
• Rapid weight gain
• Early puberty in children
• Irregular menstrual cycles in women

How is adrenocortical carcinoma diagnosed?

To confirm a diagnosis of ACC, the physician may use a combination of imaging and lab tests, such as:

• CT or MRI scans to visualize the tumor
• Blood- and urine-based hormone tests
• Biopsy to examine the tumor cells

How is adrenocortical carcinoma treated?

Because ACC tends to be aggressive, treatment is usually intensive. Options may include:

• Surgical removal of the tumor
• Medication, such as mitotane or chemotherapy
• Radiation therapy

Pheochromocytomas

Pheochromocytomas form in the adrenal medulla, the inner part of the gland. The adrenal medulla is responsible for secreting hormones (catecholamines), primarily epinephrine (adrenaline) and norepinephrine (noradrenaline), in response to signals from the sympathetic nervous system. These hormones are released into the bloodstream to trigger the body’s “fight-or-flight” response, increasing the heart rate, blood pressure and metabolism to prepare the body for short-term stress or danger. As such, a pheochromocytoma can potentially cause dangerous spikes in the heart rate and blood pressure.

What causes pheochromocytomas?

Many pheochromocytomas occur randomly, but some are linked to an inherited genetic condition, such as multiple endocrine neoplasia type 2 (MEN2) or von Hippel–Lindau disease.

What are the symptoms of a pheochromocytoma?

Excess adrenaline can cause symptoms that resemble anxiety or a panic attack, such as:

• High blood pressure that is difficult to manage
• Rapid heartbeat or palpitations
• Excessive sweating
• Intense anxiety or panic episodes
• Severe headaches

How are pheochromocytomas diagnosed?

To diagnose a pheochromocytoma, the physician may order blood or urine testing to measure the level of adrenaline-related hormones, such as catecholamines. Additionally, CT or MRI scans can help the physician pinpoint the tumor.

How are pheochromocytomas treated?

The main treatment for pheochromocytomas is surgical removal of the tumor. Before surgery, medications may be administered to stabilize the heart rate and blood pressure.

Neuroblastoma

Neuroblastoma is a type of cancer that begins in immature nerve cells, most often found in the adrenal glands. It primarily affects infants and young children, usually under the age of 10, and is among the most common pediatric cancers.

What causes neuroblastoma?

Scientists believe neuroblastoma is primarily caused by random genetic mutations in fetal nerve cells (neuroblasts), which most often occur by chance rather than being inherited. These mutations can lead to abnormal cell growth, causing tumors to form in the adrenal glands. While most cases are sporadic, a small percentage are hereditary, resulting from an inherited genetic alteration, such as in the ALK gene, passed down from a parent.

What are the symptoms of neuroblastoma?

As the tumor grows and affects nearby organs or hormone levels, it may cause symptoms, such as:

• Abdominal swelling or a noticeable mass
• Pain in the abdomen, chest or bones
• Fatigue or weakness
• Fever
• Poor appetite
• Unexplained weight loss

How is neuroblastoma diagnosed?

If neuroblastoma is suspected, the physician may order:

• Imaging scans, such as CT, MRI or ultrasound scans
• Blood and urine testing for tumor markers
• Biopsy to examine the tumor cells

How is neuroblastoma treated?

Neuroblastoma treatment can vary based on the location and stage of the tumor and the patient’s age. Options may include:

• Surgical removal of the tumor
• Chemotherapy
• Radiation therapy
• Bone marrow transplantation
• Targeted therapy (for advanced cancer)

Benefit from world-class care at Moffitt Cancer Center

The oncologists in the Endocrine Oncology Program at Moffitt have extensive experience in treating all types of adrenal tumors. To help ensure the best possible outcome and quality of life for each patient, we take a personalized approach to care, developing a tailored plan using evidence-based pathways and individual factors.

To request an appointment with a specialist on our team, call 1-888-663-3488 or submit a new patient registration form online. We do not require referrals.