Benign Adrenal Tumors - Types, Symptoms, Diagnosis and Treatment

Introduction:

The adrenal glands may grow masses on them that may be benign (noncancerous) or malignant (cancerous). These tumors sometimes tend to overproduce hormones that the adrenal glands produce (cortisol, aldosterone, epinephrine, and norepinephrine). This overproduction of the adrenal hormones can lead to multiple systemic complications that may require treatment. Adrenal tumors are of several types, and each type of these tumors presents itself with different causes and symptoms. Moreover, benign and malignant require different types of treatment.

What Are the Adrenal Glands and Their Functions?

Adrenal glands are also known as the “supra-renal glands.” These are endocrine glands located on top of each kidney, and they have two main parts that function separately. The two parts of the adrenal glands are:

• Adrenal Cortex: Outer part of the adrenal glands is known as the adrenal cortex, and it produces hormones. The three parts of the adrenal cortex produce three major types of hormones which include mineralocorticoids (aldosterone), glucocorticoids (cortisol), and androgens (sex hormones). These hormones are steroid hormones, and they are responsible for the regulation of blood pressure, maintaining an electrolyte balance, regulation of metabolism, suppression of the immune system, and reproduction.

• Adrenal Medulla: It is the innermost part of the adrenal gland, and it is responsible for the production of catecholamines (epinephrine, norepinephrine, and dopamine). These hormones are responsible for the “fight or flight” response of the body under stressful situations.

What Are Adrenal Gland Tumors?

The uncontrolled, progressive, and abnormal growth of certain tissues in the body that forms a mass is known as a tumor. When such growth happens in the adrenal gland tissues, it is known as an adrenal tumor. These adrenal tumors can either be benign (noncancerous) or malignant (cancerous). Most benign adrenal tumors are asymptomatic and do not cause much harm to the body; therefore, they do not require any treatment. Whereas some benign adrenal tumors are functioning or active, which means they overproduce the adrenal hormones and cause systemic problems, and in this case, they are symptomatic and require immediate treatment. The exact etiology of adrenal tumors is unknown.

Are Benign Adrenal Tumors Common and Inherited?

Adrenal tumors are not very prevalent; they are known to affect about two to three percent of the adult population globally. These tumors can occur at any age, but the average age of occurrence is between 40 to 50 years. Benign adrenal tumors are more common as compared to malignant adrenal tumors.

Benign adrenal tumors are generally not hereditary, which means they are not passed on from parents to their children. These tumors occur sporadically in individuals with no family history of the tumor. In addition, some genetic diseases may cause benign adrenal tumors; these include type 1 multiple endocrine neoplasias and familial adenomatous polyposis.

What Are the Risk Factors for Benign Adrenal Tumors?

Benign adrenal tumors are non-hereditary, but there are genetic conditions that increase the risk of inheriting this condition. The genetic conditions include:

• Multiple Endocrine Neoplasias: It is a hereditary condition associated with tumors of the endocrine gland.

• Von Hippel-Lindau Syndrome: It is a condition that causes tumors and cysts to grow in several parts of the body.

• Li-Fraumeni Syndrome: It is an inherited familiar condition that predisposes an individual to a wide range of rare cancers.

• Neurofibromatosis Type 1: It is a condition in which changes in the color of the skin occur along with the growth of tumors along the nerves of the skin, brain, and other parts of the body.

• Carney Complex: It is a condition associated with skin pigmentations and benign connective tissue tumors, and tumors of the endocrine glands.

What Are the Types of Benign Adrenal Gland Tumors?

The adrenal gland tumors are broadly divided into benign and malignant tumors, and the benign adrenal tumors are further classified into two categories based on their property to overproduce or not produce adrenal hormones. Apart from this, different types of benign adrenal tumors include:

• Adrenocortical Adenoma: This is also known as adenoma, and it is the most prevalent benign adrenal tumor. These tumors affect both genders equally and occur more commonly in the middle to older age. Adenomas are tumors of the adrenal cortex, and they may be functioning or functioning. A non-functioning adenoma does not produce any hormones, is generally asymptomatic, and requires no treatment. In contrast, a functioning adenoma is characterized by the ability of the tumor to overproduce adrenal hormones (glucocorticoids, mineralocorticoids, and sex hormones). This overproduction of the hormones will lead to hormonal imbalance, which in turn causes multiple conditions like Cushing’s syndrome, Conn’s syndrome, masculinization of females, feminization of males, etc.

• Incidentalomas: These are adrenal gland tumors that are discovered incidentally and unexpectedly during diagnostic testing of some other disease. These tumors are usually asymptomatic and are found in CT scans (computed tomography) or MRI (magnetic resonance imaging). In rare cases, incidentalomas may show signs of high blood pressure, flushing, anxiety, palpitation, and muscle weakness.

• Aldosteronoma and Conn’s Syndrome: It is a type of adenoma characterized by overproduction of the hormone aldosterone, which leads to a medical condition known as hyperaldosteronism or Conn’s syndrome.

• Adrenal Cortex Tumors: This is a type of adenoma with excessive production of the hormone cortisol and leads to a medical condition known as Cushing’s syndrome.

• Pheochromocytomas and Paragangliomas: Pheochromocytomas are benign adrenal tumors that produce too much of the hormone catecholamines (epinephrine and norepinephrine). Paragangliomas are a type of neuroendocrine tumor found in the stomach, pelvis, neck, etc.

What Are the Signs and Symptoms of Benign Adrenal Tumors?

Most benign adrenal tumors are asymptomatic and require no treatment, but the symptomatic ones may reflect different signs and symptoms depending upon which hormone is produced in abundance. The general signs and symptoms of benign adrenal tumors include:

• High blood pressure.

• Reduced potassium level due to electrolyte imbalance.

• Palpitations.

• Nervousness and anxiety.

• Headaches.

• Excessive sweating.

• Abdominal pain and cramps.

• Diabetes.

• Unusual weight loss or weight gain.

• Muscle and general weakness.

• Stretch marks and easy bruising.

• Excess hair growth.

• Adult acne.

• Reduced sex drive.

• Irregular menstrual cycle in women.

• Infertility in both men and women.

• Changes in the genitals.

• Heart attack or stroke (in case of pheochromocytomas).

How Are Benign Adrenal Tumors Diagnosed?

The diagnosis of a benign adrenal tumor is made based on the following factors:

1. The type of suspected tumor.

2. The clinical signs and symptoms of the patient.

3. Age, sex, and general health of the patient.

Following Tests and Examinations Are Done to Confirm the Diagnosis:

• Blood and Urine Examinations: Blood and urine samples are collected and sent to the laboratory to evaluate the levels of various adrenal hormones. The patient may be asked to collect all of their urine for 24 hours. The increased levels of cortisol hormone are done by dexamethasone suppression test.

• Biopsy: A small section of sample tissue is collected from the tumor and examined in the laboratory. A biopsy is done to check whether the tumor is benign or malignant.

• Imaging Tests: Imaging tests like a CT scan (computed tomography) or MRI (magnetic resonance imaging) may be done to assess the location, size, and functionality of the adrenal tumor.

• Adrenal Vein Sampling: In cases where the patient has the symptoms of a functioning adrenal tumor, but the imaging tests fail to identify and locate any tumor in the adrenal gland, adrenal vein sampling may be done. In this test, blood directly from the adrenal vein is collected and examined. The test will confirm whether the extra hormone is coming from the adrenal gland with the tumor.

How Are Adrenal Tumors Treated?

Benign adrenal tumors that are non-functioning and asymptomatic generally do not require any treatment. However, they do need to follow up with their healthcare provider to check whether the size of the tumor is increasing or if it has started producing hormones. Functioning benign adrenal tumors require immediate treatment, and they are typically treated with surgery. Hormone therapy, chemotherapy, or radionuclide therapy are also sometimes used to treat the condition.

Conclusion:

Benign adrenal tumors are noncancerous tumors of the adrenal glands. The exact cause of the tumors is still unknown, but several genetic factors act as predisposing factors for the growth of tumors. The benign adrenal tumors can either be functioning or non-functioning. Non-functioning tumors are asymptomatic and do not require any treatment, whereas functioning adrenal tumors cause several symptoms and do require treatment. The diagnosis and treatment of the condition are effective, and the prognosis of the treatment of these tumors is excellent.