An adrenal tumour is a growth in one of the two small hormone glands that sit on top of the kidneys. Most are benign adenomas discovered by accident on a CT or MRI done for something else, which is why they are nicknamed incidentalomas. They are found in around 3 to 5 per cent of adults scanned, more with age.
Two questions decide everything: is the lump making excess hormone, and does it look benign on imaging? Most are non-functioning and harmless and can be left alone. A minority produce cortisol, aldosterone or adrenaline-type hormones, and a small number are cancers.
Symptoms
- No symptoms in the majority
- Cortisol excess: weight gain around the trunk, a round face, easy bruising, thin skin, muscle weakness, diabetes, high blood pressure
- Aldosterone excess (Conn's syndrome): high blood pressure that is difficult to control, low potassium, cramps
- Phaeochromocytoma: attacks of pounding headache, sweating, palpitations, pallor and surges in blood pressure
- Excess androgens: new facial hair, acne or irregular periods in women
- Flank or abdominal pain with large tumours
Causes and risk factors
Why benign adenomas form is mostly unknown. They become more frequent with age, obesity, diabetes and high blood pressure. Phaeochromocytomas are inherited in up to four in ten cases (MEN2, von Hippel-Lindau, neurofibromatosis type 1 and SDH gene variants), so genetic testing is offered to everyone who has one. Adrenocortical carcinoma is rare and occasionally linked to Li-Fraumeni syndrome. The adrenal is also a common site for spread from lung, kidney, breast and melanoma cancers.
How it is diagnosed
- Dedicated adrenal CT or MRI: Density below 10 Hounsfield units on unenhanced CT indicates a fat-rich benign adenoma. Size above 4 centimetres, irregular edges or slow contrast washout raise concern.
- 1 mg overnight dexamethasone suppression test: Screens every patient for mild cortisol excess.
- Plasma or urine metanephrines: Exclude phaeochromocytoma, and must be done before any biopsy or surgery.
- Aldosterone to renin ratio: For anyone with high blood pressure or low potassium.
- Adrenal vein sampling: Shows which gland is overproducing aldosterone before surgery is offered.
- Biopsy: Rarely needed, and only to confirm spread from a known cancer after phaeochromocytoma has been excluded.
Treatment options
- No treatment or limited follow-up: A small, fat-rich, non-functioning adenoma needs no surgery, and current guidelines say many need no repeat imaging.
- Laparoscopic or retroperitoneoscopic adrenalectomy: Keyhole removal for hormone-producing tumours and indeterminate lumps, with one to three nights in hospital.
- Open adrenalectomy: For suspected adrenocortical carcinoma or very large tumours, so the tumour is removed intact.
- Pre-operative alpha blockade: Ten to fourteen days of medication and salt loading before phaeochromocytoma surgery to prevent dangerous blood pressure swings.
- Medical treatment: Spironolactone or eplerenone for aldosterone excess affecting both glands, and steroid cover after removal of a cortisol-producing tumour until the other gland recovers.
When it is urgent
A severe headache with pounding heartbeat, sweating and very high blood pressure may be a phaeochromocytoma crisis and needs emergency care. After removal of a cortisol-producing tumour, vomiting, faintness or severe weakness may signal adrenal crisis, which needs an immediate steroid injection and hospital treatment.
Travelling to Türkiye for treatment
An adrenal lump can be fully characterised in a visit of a few days (imaging review, hormone tests and an endocrine surgery opinion), and the usual result is reassurance. Keyhole adrenalectomy is planned surgery that fits a trip of 7 to 10 days. A phaeochromocytoma needs two weeks of preparation first, which can be supervised at home. Steroid replacement and blood pressure medication are adjusted over the months afterwards by your own endocrinologist.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Does an adrenal adenoma turn into cancer?
A lump with typical benign imaging features essentially never does.
Can removing the tumour cure my high blood pressure?
With a one-sided aldosterone-producing adenoma, blood pressure improves in most and normalises completely in a third to a half.
Can I live with one adrenal gland?
Yes. The remaining gland takes over, though it may need months to wake up after cortisol-producing tumours.
Why was my biopsy request refused?
Biopsy cannot tell a benign from a malignant adrenal cortical tumour and is dangerous if an unrecognised phaeochromocytoma is present.