Adrenal Cancer

Most people are born with two adrenal glands.  They are located in the back of the abdomen, just above the kidneys.  The adrenal glands produce steroids and other hormones that humans use for regular bodily functions.  These hormones help regulate blood pressure, kidney function, stress responses, and some sexual functions.

Adrenal cancer is extremely rare.  Many are discovered incidentally – meaning that they are found by chance during radiologic studies obtained for an unrelated medical condition.  Others are discovered because patients have the signs and symptoms of “hormone overload” – excessive amounts of normal hormones that result in a variety of symptoms.  Another cause of adrenal tumors is from the spread (metastasis) from another cancer (such as breast, kidney, and thyroid). 

The symptoms of adrenal tumors can include any of the following:

• No ailments or symptoms
• High blood pressure (hypertension), fast heart rate (tachycardia), flushing, and sweating.
• Anxiety and emotional imbalance.
• Weight gain, lethargy (tiredness), humping of the shoulder, blue streaks on the abdomen
• Acne and facial hair; breast development.

Specific physical findings, blood tests, urine tests, and X-ray studies are crucial to the diagnosis of an adrenal mass.  Most important is either an MRI scan or CT scan of the abdomen.  These X-ray studies are evaluated for the presence of fat.  The more fat in the lesion on MRI or CT imaging, the more likely the tumor is benign (not cancer).

Most adrenal tumors are benign – meaning that they do not spread to other parts of the bodies.  Many of these, however, can produce hormones that cause medical and physical ailments.  Some conditions are listed below:

• Pheochromocytoma: can produce high blood pressure (hypertension), a fast heart rate (tachycardia), flushing, and sweating.  Approximately 10% of pheochromocytomas are malignant, meaning that they can spread to other parts of the body (a process known as metastasis).  An MRI scan and urine tests for adrenaline and similar hormones are the best studies to diagnose a pheochromcytoma.   
• Cushing’s Disease: can produce weight gain, lethargy (tiredness), humping of the shoulder, blue streaks on the abdomen, acne, and facial hair.  Urine and blood tests will show elevated levels of cortisol. 
• Aldosteronoma: can produce high blood pressure and decreased levels of potassium.  Urine and blood tests are most useful for its diagnosis. 

The following flow sheet algorithm is used for managing adrenal tumors:

 

This algorithm is quite simplified and every adrenal tumor must be evaluated on a case-by-case system.

Surgical Treatment: Adrenalectomy

Almost all adrenal tumors are treated surgically.  Surgeons in the UMass Department of Urology are trained in the latest and most comprehensive therapies for any type of adrenal tumor and perform both open and laparoscopic surgery.  This surgery is called an adrenalectomy.

• During an adrenalectomy, the entire adrenal gland and all of the surrounding fatty tissue is removed
• Adrenalectomies can be performed in both an open or laparoscopic (minimally-invasive) manner.
• If the tumor invades surrounding organs (such as the liver or spleen) or is involving the inferior vena cava (a large blood vessel), these structures may be removed in addition to the kidney.  Depending upon the location and extent of such “locally-advanced” disease, open surgery may be indicated.

Some patients may require drug treatments prior to surgery to prevent a hormonal flare during the operation. Our anesthesiologists are specifically trained to manage these patients undergoing adrenal surgery.