Adrenal Gland Mass: Symptoms And Treatment For Adrenal Mass

An adrenal mass is a tumor or a benign mass in the adrenal glands. Adenomas / the mass are functioning, i.e. they synthesize hormones, or are non functioning.

Adrenal Gland Mass Symptoms

Common symptoms are: hypertension, diabetes, low levels of potassium, anxiety, palpitations, and stretch-marks on the abdomen.
Severe symptoms include: feeling always full / no appetite, fever, weight loss, abdominal pain and a lump in the abdomen.
Cushing’s syndrome is also related to adrenal mass.

Symptoms like acne, hirsuitism, hypertension, fatigue, and osteoporosis are associated with Cushing’s disease.
Conn’s Syndrome may also develop due to an adenoma. There occurs excessive release of hormone aldosterone that governs the electrolyte balance.
Pheochromocytoma: tumor of the adrenals that secretes hormones epinephrine and nor-epinephrine.

Treatment For Adrenal Glands

A biopsy may be carried out to confirm the diagnosis.
On the other hand, a laparotomy can be performed.

This requires an incision to permit admission in to the abdomen.
Laparoscopic Adrenalectomy: is a commonly used surgical procedure, which is highly effective in treating an adenoma. Tiny incisions are made to gain admission in to the abdomen, which is blown up like a balloon to push organs back from the instruments being used. A camera is inserted which assists the surgeon in the removal of the mass.
Abdominal Laparotomy: is a more invasive surgery with a larger opening. Certain cases necessitate an abdominal laprotomy. A large incision under general anesthesia. The removal procedure is then carried out.

Related Reading:

What is Cushing’s Syndrome?

Cushing’s syndrome is defined as a combination of symptoms and signs due to inappropriately elevated exogenous or endogenous glucocorticoid levels.

Causes of Cushing’s Syndrome

1. ACTH (adrenocorticotrophic hormone)

Cushing’s disease is the most common cause of spontaneous Cushing’s syndrome, occurring in 60-70% of people.
Ectopic ACTH secretion as in malignant or benign non-endocrine tumors.
Iatrogenic- ACTH administration for inflammatory or immunological disorders.

2. Cortisol excess (hypercortisolism)

Adrenal adenoma or carcinoma.
Corticosteroid administration for inflammatory or immunological disorders. See also Deficiency of cortisol.

Clinical features of Cushing’s Syndrome

1. Weight gain and obesity

They are the most common presenting features.
Abnormal fat accumulation- moon face, pendulous abdomen and supra-clavicular fat pads is seen.
Buffalo hump and only truncal obesity (characteristically arms and legs are thin).

2. Proximal myopathy, marked especially in quadriceps femoris (calf) group of muscle.
3. Skin changes

Skin becomes thin and its transparency produces red cheeks.
Stretching of skin is seen due to purple striae more than 1cm wide over abdomen, buttocks and upper thighs.
Skin bruises easily with numerous echymoses.
Acne is common.
Hirsutism is seen.

4.   Poor wound healing.
5.   Severe osteoporosis may lead to vertebral compression and easy fractures.
6.   Hypertension and edema due to salt retention is noticed.
7.   Mental symptoms like insomnia, excitability is common.
8.   Oligomenorrhoea or amenorrhea in females and impotence in males.
9.   Linear growth retardation in children.

Also look for Pituitary adenoma Symptoms here.

Cushing’s Syndrome Diagnosis

1. Tests indicating cortisol overproduction

24hrs urinary cortisol excretion- increased value of >90ug/day or 280nmol/24hrs is diagnostic.
Low dose dexamethasone suppression test.
Corticotrophin releasing hormone (CRH) test.

2. Imaging technique- to locate the tumor responsible for spontaneous Cushing’s syndrome.

Pituitary MRI- detects a micro-adenoma in up to 60% people.
Chest X-ray- in ectopic ACTH syndrome, most tumors are located in thorax seen as highly aggressive oat cell carcinomas or bronchial carcinomas.
CT-scan easily detects adrenocortical tumors.

Cushing’s Syndrome Management
1. Transphenoidal pituitary surgery (micro-adenectomy) – is the treatment of choice.

If surgery fails, hypercorticolism can be controlled by anti-adrenocorticol drugs.
Simultaneous radiotherapy is often indicated, allowing the anti-adrenocorticol therapy to be discontinued later.
In rare cases, bilateral adrenolectomy may be necessary.

2. Ectopic ACTH syndrome

In this surgical resection of tumor is needed in case of bronchial carcinoma of lung.

3. Adrenocorticol tumors

This again requires surgical removal and also need glucocorticoid coverage for up to 2yrs for hypoadrenalism.

Related Topics

Adrenal Gland Mass: Symptoms And Treatment For Adrenal Mass