Adrenal Tumors

Adrenal tumors are abnormal growths that develop in one or both adrenal glands, the small hormone-producing glands located above the kidneys. Many adrenal tumors are benign, but some produce excess hormones or, less commonly, are cancerous and require specialist evaluation.

Overview

Adrenal tumors are growths that form in the adrenal glands, which sit on top of each kidney. The adrenal glands make important hormones that help regulate blood pressure, salt balance, stress response, metabolism, and sex hormone levels. A tumor may develop in the outer layer of the gland, called the adrenal cortex, or in the inner part, called the adrenal medulla.

Adrenal tumors are often described in two main ways: whether they are benign or malignant, and whether they are functioning or nonfunctioning. Benign tumors are not cancer, while malignant tumors include primary adrenal cancers and tumors that have spread to the adrenal gland from another cancer. Functioning tumors produce excess hormones; nonfunctioning tumors do not produce clinically significant hormone excess.

Common types include adrenal adenomas, which are usually benign; pheochromocytomas, which arise from the adrenal medulla and can affect blood pressure; adrenal cortical tumors, which may be benign or malignant; and adrenal metastases from cancers elsewhere in the body. Because different adrenal tumors behave differently, accurate diagnosis is essential before deciding whether observation, surgery, medication, or cancer-directed treatment is most appropriate.

Symptoms

Many adrenal tumors cause no symptoms and are discovered by chance during an ultrasound, CT scan, or MRI performed for another medical reason. These are sometimes called adrenal incidentalomas. Even when a tumor is found incidentally, doctors usually check whether it is making excess hormones and whether its imaging appearance suggests a benign or more concerning process.

When symptoms occur, they often depend on the type of hormone being produced. Excess cortisol may cause weight gain around the trunk, easy bruising, muscle weakness, high blood pressure, high blood sugar, mood changes, or thinning of the skin. Excess aldosterone may cause difficult-to-control high blood pressure, low potassium, muscle cramps, fatigue, or increased thirst and urination.

Tumors that produce excess adrenaline-like hormones may cause episodes of pounding heartbeat, sweating, headaches, anxiety-like feelings, tremor, or sudden high blood pressure. Tumors that produce sex hormones may cause changes such as excess hair growth, acne, menstrual changes, reduced libido, or changes in body hair. Large tumors may cause abdominal or flank discomfort, a feeling of fullness, or back pain, although these symptoms can have many other causes.

Causes & Risk Factors

In many people, the exact cause of an adrenal tumor is not known. Some tumors arise from changes in cells of the adrenal cortex or medulla that allow those cells to grow more than usual. Most adrenal adenomas occur sporadically, meaning they are not clearly inherited and are not caused by anything the person did.

Certain inherited genetic syndromes can increase the likelihood of specific adrenal tumors, particularly pheochromocytomas or adrenal cortical tumors. These include conditions associated with endocrine tumors or rare cancer predisposition syndromes. A specialist may consider genetic counseling or genetic testing when a patient is young, has tumors in both adrenal glands, has a family history, or has tumor features linked to inherited conditions.

Risk assessment also includes the person’s medical history and cancer history. In someone with a known cancer elsewhere in the body, an adrenal mass may represent spread to the adrenal gland, although benign adrenal nodules can also occur. Tumor size, growth over time, imaging characteristics, and hormone test results all help doctors estimate risk and plan the safest next step.

Diagnosis

Diagnosis of adrenal tumors begins with a detailed medical history, physical examination, and review of prior imaging if available. The doctor asks about blood pressure, weight changes, diabetes, episodes of palpitations or sweating, muscle weakness, menstrual or sexual health changes, and any personal or family history of endocrine disease or cancer. This helps guide which tests are needed.

Hormone testing is a central part of evaluation. Blood and urine tests may assess cortisol production, aldosterone and renin balance, and adrenaline-related hormones. Testing is selected based on the patient’s symptoms, blood pressure, potassium level, and imaging findings. Because hormone levels can be affected by stress, illness, and some medications, results are interpreted by clinicians experienced in adrenal disorders.

Imaging helps determine whether the tumor has benign features or needs further investigation. Dedicated adrenal CT or MRI can assess size, density, fat content, blood-flow pattern, and washout characteristics. In selected cases, additional imaging such as nuclear medicine scans or PET imaging may be used, especially when cancer or pheochromocytoma is suspected.

A biopsy is not routinely used for most adrenal masses and is generally avoided until certain hormone-producing tumors have been excluded, because biopsy can be unsafe or unhelpful in some situations. If there is a history of cancer and imaging suggests metastasis, biopsy may be considered by a specialist team after appropriate hormone testing. Diagnosis is often reviewed by endocrinology, radiology, surgery, oncology, and pathology specialists together.

Treatment Options

Treatment for adrenal tumors depends on several factors: whether the tumor is producing hormones, whether it appears benign or malignant, its size and growth pattern, the patient’s symptoms, and the person’s overall health. The right approach is decided by a specialist after assessment, not by imaging size alone. Some patients need active treatment, while others can be followed safely with planned monitoring.

Observation may be appropriate for small, nonfunctioning tumors with clearly benign imaging features. Monitoring can include repeat imaging and hormone tests at intervals recommended by the care team. The purpose is to confirm that the tumor is stable and not beginning to produce excess hormones.

Surgery may be recommended for functioning tumors, tumors with suspicious imaging features, tumors that grow over time, or adrenal cancers when removal is feasible. Adrenal surgery may be performed using minimally invasive or open techniques depending on tumor size, location, and cancer risk. If both adrenal glands are removed or if adrenal hormone production is reduced, long-term hormone replacement and education about adrenal insufficiency may be needed.

Medication may be used to control hormone effects before surgery, to manage blood pressure or metabolic changes, or to treat adrenal hormone excess when surgery is not suitable. For malignant adrenal tumors, treatment may include surgery, systemic anti-cancer therapy, radiotherapy in selected situations, or palliative care focused on symptom control and quality of life. Decisions are usually made through a multidisciplinary tumor board so that endocrine and oncology needs are addressed together.

Living With / Prognosis

The outlook for adrenal tumors varies widely. Many benign adrenal adenomas remain stable and never cause symptoms, while functioning tumors may improve after appropriate treatment. Malignant adrenal tumors require individualized cancer care and closer follow-up, because the behavior of the disease depends on tumor type, stage, hormone activity, and response to treatment.

Living with an adrenal tumor often means attending scheduled follow-up appointments and completing recommended blood, urine, and imaging tests. Patients may be asked to monitor blood pressure, blood sugar, weight, and symptoms such as palpitations, weakness, or fatigue. Keeping an updated list of medications and previous imaging reports can help doctors compare changes over time.

After adrenal surgery, recovery depends on the type of operation and the patient’s health before treatment. Some people need temporary or long-term hormone replacement, and they should understand how and when to seek medical advice if symptoms of low adrenal hormone levels occur. Emotional support is also important, especially when the tumor is cancerous or when repeated monitoring causes worry.

Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals diagnose and treat adrenal tumors for international patients, coordinating endocrinology, oncology, surgery, imaging, pathology, and follow-up care when needed. Patients should always discuss personal prognosis and treatment choices with a qualified doctor who can interpret their test results in context.

When to See a Doctor

A person should see a doctor if an adrenal mass is reported on any imaging test, even if there are no symptoms. Most adrenal findings are not emergencies, but they should be evaluated to determine whether hormone testing or follow-up imaging is needed. Bringing the original scan report and images to the appointment can speed up assessment.

Medical evaluation is especially important if there are symptoms suggesting hormone excess, such as difficult-to-control high blood pressure, repeated episodes of rapid heartbeat and sweating, unexplained low potassium, new diabetes or worsening blood sugar, unusual weight gain with muscle weakness, easy bruising, or unexplained changes in hair growth or menstrual patterns. These symptoms do not always mean an adrenal tumor is present, but they deserve careful review.

Urgent medical care is needed for severe symptoms such as chest pain, fainting, severe headache with very high blood pressure, confusion, severe dehydration, or sudden weakness. Patients already diagnosed with an adrenal condition should ask their doctor what warning signs require urgent attention, particularly if they are taking hormone replacement or preparing for surgery.

Frequently asked questions

What is an adrenal tumor?

An adrenal tumor is an abnormal growth in one of the adrenal glands, which are hormone-producing glands located above the kidneys. It may be benign or cancerous, and it may or may not produce excess hormones. Evaluation usually focuses on both cancer risk and hormone activity.

Are adrenal tumors usually cancer?

Many adrenal tumors are benign, especially small adrenal adenomas found incidentally on imaging. However, some adrenal tumors are malignant or represent cancer that has spread from another organ. Imaging features, hormone tests, growth over time, and medical history help specialists assess risk.

What symptoms can adrenal tumors cause?

Some adrenal tumors cause no symptoms. Functioning tumors may cause high blood pressure, palpitations, sweating, headaches, weight changes, muscle weakness, high blood sugar, low potassium, or changes in hair growth and menstrual patterns. Symptoms vary depending on which hormone is overproduced.

How are adrenal tumors diagnosed?

Diagnosis usually includes a medical history, physical examination, hormone testing, and dedicated adrenal imaging such as CT or MRI. Blood and urine tests may check cortisol, aldosterone-related hormones, and adrenaline-related hormones. Biopsy is not commonly the first test and is only considered in selected cases after specialist review.

Do all adrenal tumors need surgery?

No. Small, nonfunctioning tumors with benign imaging features may only need observation and follow-up. Surgery is more likely to be considered when a tumor produces excess hormones, grows, causes symptoms, or has features suspicious for cancer. A specialist decides the safest approach after complete assessment.

Can adrenal tumors come back after treatment?

Some adrenal tumors can recur, particularly malignant tumors or certain hormone-producing tumors, so follow-up is important. Benign tumors that are completely removed often have a good outlook, but the need for monitoring depends on the tumor type and hormone results. Patients should follow the schedule recommended by their care team.

Which doctor treats adrenal tumors?

Adrenal tumors are often managed by an endocrinologist, with input from endocrine surgeons, radiologists, oncologists, pathologists, and sometimes genetic specialists. If cancer is suspected or confirmed, an oncology team is involved. Multidisciplinary care helps ensure that both hormone-related and cancer-related issues are addressed.

References

• Endocrine Society
• European Society of Endocrinology
• National Cancer Institute
• American Association of Endocrine Surgeons
• American Cancer Society

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.