Adrenal Incidentaloma

What is an adrenal incidentaloma?

An adrenal incidentaloma is an unsuspected tumor in one or both of your adrenal glands. This type of tumor is usually found by chance during an imaging test, such as an ultrasound or CT scan, for another condition.

What causes an adrenal incidentaloma?

There are a number of causes including:

• An adenoma (a non-cancerous tumor in the adrenal glands)
• Cancer of the adrenal gland or spread of cancer from elsewhere in the body
• Cysts in or on the adrenal glands
• Other less common conditions, such as tumors filled with fat and blood cells

Adrenal tumors can be non-functional or functional. Functional adrenal tumors make hormones in higher amounts than normal. Both cancerous and non-cancerous tumors can produce too much hormone. Tumors can sometimes make too much of more than one hormone.

These hormones include: 

1. Cortisol - Cushing syndrome or subclincial hypercortisolism are conditions caused by too much cortisol 
2. Aldosterone - Primary aldosteronism is a condition caused by too much aldosterone 
3. Adrenaline hormones (epinephrine and norepinephrine) - Pheochromocytomas are rare adrenal tumors that produce too much adrenaline hormone
4. Androgens (testosterone and testosterone building blocks) 

What are the symptoms of an adrenal incidentaloma?

Even when discovered incidentally, adrenal tumors may cause symptoms. Symptoms vary depending on whether the tumor is non-functional or functional, and which, if any, hormones are produced in excess.

Symptoms of too much cortisol can include:

• Weight loss or weight gain (especially around the face and abdomen)
• Purplish skin stretch marks or skin that’s easily bruised
• Acne
• Muscle weakness
• Depression, anxiety, fatigue, and sleep disturbances
• In women, excess facial and body hair and/or irregular periods

High levels of cortisol can also cause high blood pressure, high blood sugar, and low bone density (when the tissue inside your bones starts to thin).

High levels of aldosterone can cause high blood pressure, and sometimes muscle weakness.

Symptoms of too much norepinephrine or epinephrine can include:

• Fast or irregular heartbeat
• Sweating
• Severe headaches
• Shakiness
• Pale face
• High blood pressure .

High levels of androgens can lead to hair growth, acne and irregular periods in women. 

How is an adrenal incidentaloma evaluated?

Your doctor will evaluate your tumor to identify its cause and hormone production. This may include:

• Your medical history
• A review of your symptoms
• A physical exam: a check of your blood pressure, pulse rate, body weight, and other signs
• Blood and/or urine tests to check hormone levels and to rule out hormone excess
• Results of genetic tests (rarely)

Your doctor also will need to know your family history of adrenal tumors, other kinds of tumors, syndromes that come with tumors, high blood pressure, or Cushing syndrome.

What is the treatment for an adrenal incidentaloma?

About 85% of adrenal tumors are non-functioning and may not need treatment. Sometimes surgery is needed to remove the tumor, or one or both adrenal glands. Your medical team will decide whether you need surgery based on your type of tumor (benign or cancerous) and whether it is producing hormones. If you have an inherited tumor syndrome, you may need genetic counseling.

If you’ve had an adrenal incidentaloma, you may need regular follow-up.

Questions to ask your doctor

• Do I have a hormonally active tumor?
• What tests do I need?
• What are my options for treatment?
• What are the risks and benefits of each treatment option?
• How long will I need treatment?
• How often will I need check-ups?
• Should I see an endocrinologist?