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What are Adrenal Glands?
Adrenal glands are triangular-shaped glands located on top of the kidneys. The adrenal glands are an endocrine gland, which means they make hormone.
Adrenal glands make:
- Sex Hormones
- Epinephrine and norepinephrine (aka adrenaline and noradrenaline)
Adrenal Nodules, Adrenal Masses, Thickened Adrenal Glands, and Adrenal “Incidentalomas”
When patients have images taken of their abdomen with a CT scan or MRI, it is very common to see an adrenal nodule. In fact, we see adrenal nodules in 4 out of every 100 people that get a CT or MRI. An adrenal nodule is when normal tissue grows into a lump. Most incidental adrenal nodules do not cause health problems. However, they need to be evaluated for signs of excess hormone production or suspicion of malignancy. Because we often find adrenal nodules or masses when we were not looking for them, doctors will informally call these “incidentalomas.”
If you discover that you have an adrenal nodule, it is important to have a proper workup. Phone: 310-267-7838
Work-up of Adrenal Nodules: Functional or Non-Functional?
At UCLA Endocrine Center, we start by performing a comprehensive review of a patient’s history and thorough physical exam. We are looking for signs that the adrenal nodule may be making too much hormone. Most adrenals nodules do not produce hormones.
When nodules make hormone, doctors refer to them as “functional.” When nodules do not make hormone, they are “non-functional.”
85% of adrenal nodules are non-functional
15% of adrenal nodules are functional
9% make the stress hormone cortisol
4% make epinephrine and norepinephrine
2% make aldosterone
<1% make sex hormones
Sometimes patients feel completely normal despite making excess hormones. That is why we will typically perform regular lab testing for all the mentioned hormones when an adrenal tumor is found. Sometimes, this involves blood tests. Sometimes, this requires urine testing. In rare circumstances, we will also recommend a biopsy of the adrenal tumor.
What are the Signs and Symptoms of an Adrenal Nodule?
When abnormal amounts of the aforementioned hormones are secreted by functioning tumors, they can cause serious abnormalities in the body.
Adrenal Causes of High Blood Pressure
UCLA endocrine surgeon Masha Livhits, MD, presented a live-streaming webinar to discuss an overview of adrenal hormones and their role in causing high blood pressure, when adrenal hormone levels should be checked and what are the treatment options.
When adrenal tumors make too much cortisol, this is called Cushing’s syndrome. Patient with Cushing’s syndrome may experience:
- High blood pressure
- High blood sugar (diabetes)
- Weight gain, especially in cheeks and shoulders
- Menstrual irregularities
- Weakening of muscles and bones
- Skin changes
- Easy bruising
- Purple striae (stretch marks)
- Rarely, can raise sex hormones that causes women to grow facial hair, voices to deepen, balding, etc
When adrenal tumors make too much epinephrine or norepinephrine, this is called a pheochromocytoma. Patients with a pheochromocytoma may experience:
- Episodic headaches
- Fast heart rate
- High blood pressure (can be always or sometimes)
When adrenal tumors make too much aldosterone, this is called a Conn’s syndrome or hyperaldosteronoma. Patients with a hyperaldosternoma may experience:
- High blood pressure that is not well controlled on multiple drugs
- You may be told your potassium levels are low on blood testing
Do Adrenal Nodules Contain Cancer?
Adrenal Surgeons at UCLA
Cancers that come from the adrenal gland are called adrenocortical carcinomas, and they are very, very rare. Adrenocortical carcinomas occur in about 0.0001% of people, or 1 in one million of the population per year in the United States. These cancers, just like nodules, can be functional or non-functional.
There are no obvious symptoms or signs unless the adrenal cancer is producing excessive hormones. This makes it hard to detect at an early stage.
There are some characteristics that are concerning for adrenal cancer: when the mass has irregular borders, when the tumor is bigger than 4 cm, when there are enlarged lymph nodes, nearby, and when we can detect distant metastases. Distant spreading ACCs generally metastasize to the lungs, liver, bone, and lymph nodes. It remains controversial, however, whether functioning or nonfunctioning tumors are more aggressive.
Other Cancers Traveling to the Adrenal Gland
There are some cancers that arise from other parts of the body that can spread (or metastasize) to the adrenal gland. These include breast cancer, lung cancer, and melanoma. When we evaluate patients with adrenal tumors, this includes a thorough review of a patient’s history and making sure your cancer screening in up to date. Sometimes, if the only site of spread is to the adrenal gland, surgical removal of the disease can help improve patient outcomes. This decision is made by team consensus after thorough review of the case.
What Causes Adrenocortical Carcinoma?
The answer is unknown. There is no known association with smoking, alcohol consumption, or other occupational or environmental exposures. Genetic factors may play a role in a small number of patients.
How Can Adrenocortical Carcinoma Be Treated?
Early stage disease is highly curable through surgical resection of the tumor by specially trained surgeons who specialize in treating this disease. The problem is that many, if not most, adrenal cancers are found at advanced stages.
Treatment of adrenal cancer should always be done by a team of experts. An example of a team of physicians dedicated to this challenge is the UCLA endocrine surgery team. Any patient with this rare disease should be encouraged to seek, at minimum, evaluation at a center like UCLA's, which is dedicated to treatment of these rare tumors. We work with endocrinologists, endocrine surgeons, oncologists, radiologists, and pathologists to make decisions at every step along the way.
If the tumor can be fully removed, surgical resection is recommended. After surgery, mitotane treatment (a drug therapy) and/or chemotherapies may be utilized to potentially improve cure rates and increase survival. The need to use mitotane or chemotherapy should be decided on a case by case basis.
Contact us for more information or to request an appointment.