Is My Adrenal Nodule Causing Me to Gain Weight?

Hi, I’m Dr. Masha Livhits, endocrine surgeon at UCLA Health. One of the most common questions I hear from patients with adrenal nodules is:

“Could this be the reason I’m gaining weight?”

It’s a great question—and the answer is, sometimes yes, but usually no. Let’s go through this in more detail.

First, let’s talk about what the adrenal glands do. The adrenal glands are two small glands that sit on top of your kidneys. They make important hormones that help regulate how your body holds on to salt and water, which affects your blood pressure. They also produce hormones that control your metabolism to some extent and your body’s response to stress.

Sometimes, imaging—like a CT scan or MRI—done for something completely unrelated picks up an adrenal nodule. These are called adrenal incidentalomas because they’re found incidentally, when you're getting scanned for something else.

Most adrenal nodules discovered incidentally are small, benign, and not doing anything harmful. But sometimes they can produce excess hormones—and that’s when they can start to cause symptoms, including weight gain.

So if you’ve been gaining weight and you’ve been told you have an adrenal nodule, we want to check whether the nodule is making too much of any hormone.

One hormone we look at closely is cortisol, which is your body’s natural stress hormone. If an adrenal nodule is making too much cortisol, that can lead to a condition called Cushing’s syndrome..

Too much cortisol over time can cause:

Weight gain, especially around the abdomen and upper back
A rounder face, sometimes called a “moon face”
Easy bruising or thinning of the skin
Muscle weakness
Elevated blood pressure causing hypertension or elevated blood sugar causing diabetes

Again, most adrenal nodules do not cause hormone problems. In fact, about 85 to 90% of adrenal nodules are non-functioning, meaning they don’t make any extra hormones at all. That’s why we don’t want to just surgically remove any adrenal nodule that we discover, since in most cases we won’t be helping the patient. It is very important to get hormonal testing, which is done with blood or urine testing, to check for hormone overproduction when we first find an adrenal nodule. We check for excess cortisol, as well as two other hormones:

Aldosterone, which can cause high blood pressure and low potassium
And catecholamines, which is adrenaline hormone that can cause episodes of high blood pressure, fast heart rate, sweating, and headaches

If all those tests come back normal—and the nodule isn’t very large—the nodule likely doesn’t require any treatment.

But if the nodule is making extra cortisol, and you’re noticing signs like unexplained weight gain, we will probably recommend surgery. That’s because long-term cortisol excess can increase your risk for diabetes, osteoporosis, and heart disease.

So to answer the original question: Is your adrenal nodule causing you to gain weight?

The only way to figure out whether the adrenal nodule is producing too much cortisol is to evaluate the hormone levels with blood and/or urine testing.
If the cortisol evaluation is normal and the nodule is non-functioning—which most are—then it’s not responsible for weight gain.
But if it is producing cortisol, then yes, it could be contributing to weight gain, and surgery will probably be indicated.

I’m Dr. Masha Livhits, endocrine surgeon at UCLA Health. Thanks for watching this video about the possibility of weight gain caused by an adrenal nodule.