Adrenal Cysts - Symptoms, Diagnosis, and Management

What Are Adrenal Cysts?

As the name suggests, adrenal cysts occur on the surface of the adrenal glands. The adrenal glands are present above the kidneys, so they are also known as the suprarenal glands. The adrenal glands mainly consist of two parts, the adrenal cortex and the adrenal medulla. Each part of the adrenal gland is designed to produce specific hormones. The adrenal glands produce hormones that maintain the salt and sugar levels of the blood. The adrenal gland is responsible for controlling the person's response in stressful situations.

Adrenal cysts are one of the major problems of the adrenal glands. A cyst is a pathologic cavity that forms in any body organ. They are usually filled with fluids and are of varying sizes. When these cysts form on the surface of adrenal glands, the condition is known as an adrenal cyst. The condition usually goes unnoticed because the patient rarely presents with any symptoms.

What Are the Different Types of Adrenal Cysts?

Adrenal cysts do not have a definitive cause, but they can be classified into four categories. The different types of adrenal cysts are listed below:

1. Pseudocysts - Pseudocysts or false cysts form on the surface of the pancreas. They are named pseudocysts because they are formed due to the leakage of fluids from the pancreas. The pancreas plays a vital role in the human body. It is present behind the stomach and makes fluid for the small intestine. This fluid helps in the digestion of food. The problem arises when this fluid leaks out of the pancreas due to pancreatitis (inflammation of the pancreas). As a result, this fluid accumulates on the surface of the pancreas, resulting in pancreatic pseudocysts.

2. Endothelial Cysts - Adrenal endothelial cysts rarely occur in females. The patient experiences abdominal pain due to an endothelial cyst. It is difficult to diagnose small cysts, but the doctor might detect them when surgical procedures are carried out near the adrenal glands. A biopsy must be done to determine whether the cysts are benign (non-cancerous) or malignant (cancerous).

3. Epithelial Cysts - As the name suggests, these cysts contain a lining known as the epithelium and are known as true cysts. Adrenal epithelial cysts occur rarely and account for only nine percent of all adrenal cysts.

4. Hydatid Cysts - Hydatid cysts rarely occur on the surface of the adrenal glands. Parasites mainly cause these cysts, and the organs most commonly affected due to hydatid cysts are the lungs and the liver.

What Are the Signs and Symptoms of Adrenal Cysts?

If the cysts are small, the patient is usually asymptomatic. However, the following symptoms are seen if the cysts are large:

• The patient presents with pain in the lower back and the abdominal region.

• Cysts larger than 10 centimeters cause problems in the gastrointestinal tract.

• Presence of a lump or a mass in the abdomen.

• Dyspnea or shortness of breath is commonly seen.

• The cysts might rupture, resulting in bleeding from the abdomen.

• Infection in the adrenal gland.

What Methods Are Used to Diagnose Adrenal Cysts?

Adrenal cysts are usually small in size and go unnoticed. They are diagnosed incidentally on an ultrasound or during surgical procedures involving the adrenal glands. The diagnostic methods have been described below:

• Physical Examination - The doctor examines the patient to check the physical signs of adrenal cysts. Usually, the patient presents with the problem of abdominal pain, so a mass might be felt when the abdomen is palpated. Also, the blood pressure and weight are checked because patients suffering from adrenal cysts usually have high blood pressure.

• Laboratory Tests:

  • Urinalysis - In this test, the patient has to collect the urine in a container. The urine sample is then submitted to the laboratory for examination under a microscope by a lab technician. Usually, the urine outputs remain normal in patients suffering from adrenal cysts. However, the doctor recommends this test to check the condition of the kidneys.

  • 24-Hour Urine Test - As the name suggests, a 24-hour urine test means the patient needs to collect the urine in a container throughout the day. The urine sample is sent to the laboratory the next day. As the adrenal glands are located above the kidneys, this test is recommended to check if the cysts have damaged the kidneys.

  • Blood Tests - The doctor might ask the patient to undergo a blood test to check the hemoglobin concentration and sugar levels. Blood glucose levels might be impaired in patients suffering from adrenal cysts.

• Imaging Tests:

  • Ultrasound - In this imaging procedure, sound waves reach the body organs through a device called a transducer. The doctor moves the transducer over the abdomen at different angles to obtain images of the internal organs. Thin-walled cystic lesions are visible on the ultrasound.

  • Computed Tomography (CT) Scans: It produces three-dimensional (3D) images of the body organs using computer technology and X-rays. The presence of stones, tumors, and infections in any organ of the body can be easily detected by computed tomography (CT) scans. It is one of the most effective methods to diagnose adrenal cysts.

How to Manage Adrenal Cysts?

No definite treatment plans are available for managing adrenal cysts because only 600 cases have been reported in the medical literature. The management of adrenal cysts can be done as follows:

• Adrenalectomy - Adrenalectomy is a procedure in which the adrenal glands are removed surgically. There are two ways by which this surgery can be carried out. The two methods of adrenalectomy have been described below:

  • Laparoscopic Surgery - It is a minimally invasive procedure in which the doctor makes severe small incisions in the abdomen. A telescope-like instrument known as a laparoscope is inserted through these incisions. As the laparoscope consists of a camera, it helps the doctor visualize the glands' surface. Surgical instruments are passed through the laparoscope to remove the gland.

  • Open Surgery - In this procedure, a large incision is made in the abdomen to remove the glands. The advantage of laparoscopic surgery over open surgery is that the patient experiences minimal surgical trauma, and the healing is fast.

• Adrenal Sparing Surgery - As the name suggests, this surgery aims to save the adrenal glands. There are two adrenal glands present above the kidneys on either side. The patient needs hormonal injections after the surgery if both glands are removed. So, the adrenal sparing surgery aims to remove only those tissues of the adrenal gland that have got damaged due to cysts.

• Follow-ups - If the cysts are very small in size, the doctor might not recommend any treatment and keep the patient on follow-up. During the follow-up visits, the adrenal glands might be examined by imaging tests like ultrasound and computerized tomography (CT) scans.

Conclusion:

Cysts are fluid-filled sac-like structures that can form in any body organ. When these cysts originate from the adrenal glands, they are known as adrenal cysts. The adrenal glands are present above the kidneys, consisting of two parts. The main job of the glands is to produce the hormones responsible for maintaining the body's sugar levels. The gland also controls the response of a person in stressful situations. When cysts form on the surface of the glands, their activities get impaired. As a result, the person presents with abdominal pain, swelling, hypertension, and bleeding. Sometimes, the cysts are too small, and the patient might not require any treatment. However, surgical intervention is required when the cysts are larger than 10 centimeters. Consult the doctor to know more about adrenal cysts and their treatment options.