Adrenal masses are present in 5-10% of all individuals and the gross majority are benign.
Most are found incidentally on abdominal imaging performed for unrelated reasons. Occasionally, patients present with symptoms of a functional tumor and an adrenal mass is discovered as part of the workup.
Types of Adrenal Masses
Non-functional benign tumors and cysts
Functional tumors can produce one of the following hormones
Most incidentally discovered adrenal masses or cysts have no symptoms. If a tumor is producing adrenal hormones, then patients can experience various symptoms relating to the particular hormone produced such as excess cortisol, aldosterone, or catecholamines.
Occasionally, large tumors can also produce back or abdominal pain because of impingement on the diaphragm or other abdominal organs.
Risk Factors of Adrenal Masses
The only known risk factors for adrenal masses and cancer are certain genetic syndromes and mutations. The most common of these are: Multiple Endocrine Neoplasia Syndrome types 2A and 2B (MEN 2A and 2B), von Hippel-Lindau Syndrome (VHL), Neurofibromatosis 1 (NF1)).
Diagnostic Tests for Adrenal Masses
The diagnostic workup of adrenal masses consists of blood tests, sometimes urine tests, and imaging which determine if the adrenal mass is producing hormones and if it has suspicious imaging features. Certain medications can give a false positive result, so if your numbers are mildy elevated your physician may choose to repeat your labs and/or adjust your medications first.
Do I need surgery?
Surgery is generally reserved for tumors that are making hormones (determined by your lab tests), growing in size over time, larger (> 3-4cm) tumors or cysts, or masses that have very suspicious radiologic characteristics. This should be performed by a specialized adrenal, endocrine surgeon.