Adrenal Gland Tumors: Causes, Symptoms, Diagnosis and Treatment — Overview, Diagnosis & Treatment Options | MyMedicPlus

Name: Adrenal Gland Tumors: Causes, Symptoms, Diagnosis and Treatment
Published: 2026-06-26

Updated: 2026-06-26

Quick Facts

Cancer Type

Adrenal Adenoma, ACC, Pheochromocytoma (mixed)

Key Biomarker

Cortisol, Aldosterone/Renin, Metanephrines, TP53 (ACC)

Treatment

Laparoscopic Adrenalectomy; Mitotane + EDP (ACC); Alpha-Blockade (Pheo)

5- Year Survival

>95% (benign); 35-45% (ACC resected); <15% (ACC metastatic)

Last Reviewed

2026-06-15

Reviewer

MyMedicPlus Medical Review Board

Overview: Adrenal Gland Tumors

Adrenal gland tumors encompass benign adenomas (most common, found in 4-7% of CT scans as incidentalomas), pheochromocytomas, adrenocortical carcinomas (ACC), and metastatic deposits. The adrenal gland has two compartments: the cortex (producing cortisol, aldosterone, androgens) and the medulla (producing catecholamines). Evaluation differs significantly based on functional status and malignancy risk.

Causes & Risk Factors

ACC is associated with Li-Fraumeni syndrome (TP53), MEN1, Beckwith-Wiedemann, and Lynch syndrome. Pheochromocytoma: hereditary in approximately 40% (VHL, MEN2, NF1, SDH mutations). Cushing's disease (ACTH-dependent) differs from adrenal Cushing's (ACTH-independent: adrenal adenoma or ACC). Most adrenal tumors are sporadic incidentalomas without identified genetic cause.

Symptoms & Signs

Non-functioning adenomas are asymptomatic incidentalomas. Cortisol-secreting: Cushing's syndrome (moon face, central obesity, buffalo hump, purple striae, easy bruising, hypertension, diabetes). Aldosterone-secreting (Conn's syndrome): hypertension and hypokalemia. Androgen-secreting ACC: virilization in women. ACC: weight loss, abdominal pain, flank mass, and signs of hormone excess. Pheochromocytoma: paroxysmal hypertension, headache, sweating.

Diagnosis & Staging

CT adrenal protocol (Hounsfield units <10 HU and >60% washout suggest adenoma). MRI for ambiguous lesions. Hormonal workup: overnight dexamethasone suppression test for hypercortisolism; aldosterone-to-renin ratio for hyperaldosteronism; plasma or urine metanephrines for pheochromocytoma; DHEA-S, testosterone for androgen excess. FDG-PET/CT for ACC staging. 123I-MIBG or 68Ga-DOTATATE PET for pheochromocytoma.

Treatment Options

Non-functioning adenoma <4 cm with benign imaging features: surveillance (repeat CT at 6-12 months). Functioning adenomas: laparoscopic adrenalectomy. ACC: en bloc surgical resection is the cornerstone; mitotane adjuvant therapy reduces recurrence. Advanced ACC: EDP-M (etoposide, doxorubicin, cisplatin plus mitotane). Pheochromocytoma: alpha-blockade preoperatively, then laparoscopic adrenalectomy. Conn's syndrome: adrenalectomy or mineralocorticoid antagonists.

Prognosis & Outlook

Benign adrenal adenomas: excellent outcomes with observation or surgery. ACC: 5-year OS approximately 35-45% for resected disease; less than 15% for metastatic disease. Complete surgical resection is the most important prognostic factor for ACC. Pheochromocytoma: over 95% cure rate with adequate surgical preparation and laparoscopic adrenalectomy, with careful long-term surveillance.

Frequently Asked Questions

An adrenal incidentaloma is an adrenal mass discovered incidentally on imaging performed for non-adrenal indications. Found in approximately 4-7% of CT scans, the majority (approximately 80%) are benign non-functioning cortical adenomas. Evaluation requires hormonal workup (to exclude subclinical hypercortisolism, Conn's syndrome, pheochromocytoma) and size-based malignancy risk assessment.

On non-contrast CT, adrenal adenomas are lipid-rich and typically measure less than 10 Hounsfield units (HU). On contrast-enhanced CT, an absolute washout >60% or relative washout >40% at 15-minute delayed imaging is diagnostic of benign adenoma. Masses with >10 HU on unenhanced CT or poor washout require further evaluation with MRI chemical shift imaging or biopsy.

Mitotane (o,p'-DDD) is an adrenal-specific cytotoxic drug that inhibits cortisol synthesis and is directly adrenolytic. It is used as adjuvant treatment after complete surgical resection of high-risk ACC (Ki-67 >10%, Stage III, microscopic positive margins) and as palliative treatment for metastatic ACC, typically combined with EDP chemotherapy. Monitoring serum mitotane levels (target 14-20 mg/L) is essential.

Screening: aldosterone-to-renin ratio (ARR) in hypertensive patients, especially with hypokalemia or resistant hypertension. Confirmation: sodium loading test or fludrocortisone suppression test. Localization: CT adrenal; adrenal vein sampling (AVS) essential to determine laterality. Treatment: unilateral adrenal adenoma — laparoscopic adrenalectomy achieves cure in approximately 50% of patients. Bilateral disease: lifelong mineralocorticoid antagonist (spironolactone, eplerenone).

References

National Cancer Institute (NCI). cancer.gov
American Cancer Society. cancer.org
UpToDate clinical decision support. uptodate.com
NCCN Clinical Practice Guidelines in Oncology. nccn.org

Medically Reviewed

Our medical content follows strict editorial guidelines to ensure accuracy and reliability.

Up to Date

Last updated: 2026-06-26

Important: This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.

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