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General Surgery

Adrenal Tumor

Adrenal glands are organs located at the top of both kidneys that secrete vital hormones regulating the body's stress response, metabolism, and blood pressure. Tumors developing in these glands present a wide clinical spectrum based on whether they produce hormones and whether they are benign or malignant.

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ℹWhat is Adrenal Tumor?

The adrenal gland consists of two parts: the medulla (center) and the cortex (surrounding it). Different hormones are produced in these two sections. Adrenal tumors can produce various types of hormones depending on the cells they originate from, causing clinical problems in the systems they affect.

Adrenal glands produce Cortisol (stress response), Aldosterone (blood pressure), Adrenaline/Noradrenaline, and certain androgen hormones (DHEA, DHEAS, Androstenedione).

Classification

They are classified based on two main criteria: whether they produce hormones and whether they are Benign/Malignant.

  • Adrenal Adenoma: Usually benign. Some may cause diseases by uncontrolled secretion of Cortisol or Aldosterone, while others do not produce hormones.

  • Pheochromocytoma: Develops from the medulla section of the adrenal gland. It can cause high blood pressure, palpitations, sweating, and headaches by secreting Adrenaline or Noradrenaline.

  • Adrenocortical Carcinoma: A rare but aggressive cancer developing from the cortex.

Common Symptoms

Excess Cortisol (Cushing's Syndrome)
Rounding of the face (moon face), fat accumulation on the shoulders (buffalo hump), purple abdominal striae (stretch marks), muscle weakness, osteoporosis, hypertension, and difficulty in blood sugar control.
Excess Aldosterone (Conn's Syndrome)
Hypertension that is difficult to control with medication, muscle cramps due to low potassium, fatigue, and fainting spells.
Pheochromocytoma Symptoms
Sudden onset of severe headaches, palpitations, excessive sweating and tremors, and a sense of impending doom.
Excess Androgen
Excessive hair growth (hirsutism) in women, deepening of the voice, menstrual irregularity, and acne.
Adrenocortical Carcinoma
Abdominal pain, excessive hair growth, gynecomastia, hypertension, hyperglycemia, and weight loss.

Diagnosis Methods

Physical Examination and ECG
Measurement of blood pressure, checks for specific types of fat distribution, striae, and excessive hair growth.
Laboratory Analyses
Serum cortisol, ACTH, aldosterone, aldosterone/renin ratio, potassium, DHEA, and estrogen levels; 24-hour urinary metanephrine/normetanephrine levels.
Radiological Evaluation
Computed Tomography (CT), Magnetic Resonance Imaging (MRI), FDG PET-CT, and MIBG Scintigraphy.
Biopsy
When necessary, tissue samples are taken for pathological examination.

Causes

Adrenal Adenoma
Generally benign tumors that can be detected incidentally on ultrasound, CT, or MRI scans. Some are hormonally active, while others are inactive.
Pheochromocytoma
Catecholamine-secreting tumors developing from the medulla, the inner part of the adrenal gland.
Adrenocortical Carcinoma
A rare but aggressive type of cancer developing from the cortex, the outer part of the adrenal gland.

Treatments

Surgery (Adrenalectomy)
The primary treatment for hormone-active tumors and adrenocortical carcinoma cases is the removal of the adrenal gland along with the mass. Laparoscopic, robotic, or open surgery can be performed.
Mitotane
Used in adrenocortical carcinoma to reduce the risk of recurrence after surgery.
Immunotherapy
Used in adrenocortical carcinoma, particularly in cases where metastasis to the lungs and liver has developed.
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