The ADRENAL GLANDS are a pair of small glands, each of which is located just above the kidneys. The kidneys are also paired and are located in the deep abdominal area. The adrenal gland is basically made of 2 parts.
1) The CORTEX or the outer part of the adrenal gland, is where most tumours occur. The cortex’s function is to make and secrete particular hormones for the body. These adrenocortical hormones all have alike chemical structures and are collectively called steroids. These are
- Cortisol (Glucocorticoids)– aids the body in handling stress.
- Aldosterone (Mineralocorticoids)- aids the kidneys in regulating blood and body salt, & therefore blood pressure.
- Sex Hormones- Adrenal sex hormones can be transformed to more common forms of the sex hormones estrogen and testosterone. The amount of these hormones that are contributed by adrenal androgens is significantly small compared to what is synthesized in the other body parts.
2) The MEDULLA or the inner part of the adrenal gland, is what produces the fear, flight, fright hormones- norepinephrine and epinephrine (also known as adrenaline).
What are adrenal tumors ?
Adrenal tumours are basically tumours of the adrenal gland. They can occur either in the cortex (adrenal cortical tumours) or the medulla (adrenal medullary tumours). They can either be benign or malignant. Adrenal tumours are classified as either functional (producing hormones) or non-functional (not producing hormones).
Tumours and cancers that initiate in the adrenal cortex are benign adrenal adenomas (far more common) or malignant adrenal carcinomas.
Tumours and cancers that initiate in the adrenal medulla include mostly benign pheochromocytomas and also neuroblastomas.
They can again be of two types, that is, either primary or secondary-
- Primary cardiac tumours arise within the adrenal gland tissue itself and are quite rare. A vast majority of all primary cardiac tumours are benign.
- Secondary cardiac tumours arise elsewhere (extra-adrenal neoplasms with primary origin from elsewhere such as the blood and bone marrow), and are deposited in the adrenal gland tissue to cause a secondary tumour. These secondary tumours are far more frequent.
What are the types of adrenal tumors ?
The majority of primary tumours are benign such as benign adenomas.
Even myelolipomas (benign neoplasms composed of mature adipose cells and hemopoietic tissue in varying proportions) can occur and are hormonally inactive.
Adrenal carcinoma is a rare disease that carries a poor prognosis and accounts for 0.2% of all cancer deaths.
A malignant secondary adrenal tumour usually occur secondary to a known malignant process elsewhere, mostly from the nearby breast, lung or stomach.
What are the causes of adrenal tumors ?
The majority of the tumours are sporadic; nonetheless, some of these malignancies can constitute part of hereditary syndromes such as the Li-Fraumeni syndrome, the Beckwith-Wiedemann syndrome, the multiple endocrine neoplasia (MEN) 1, as well as in congenital adrenal hyperplasia and B-catenin mutations.
What are the clinical features of adrenal tumors ?
Adrenal Tumours, if functional, that is producing hormones, they cause fluid retention and weight gain, premature and accelerated puberty in children, or excessive facial or body hair growth in women.
Large tumours can cause pain or a full feeling, and start to press on other organs in the abdomen. In general, adrenal carcinomas (malignant) are far larger than adrenal adenomas (benign). An adrenal tumour exceeding 5 to 6 centimetres is thought to be a possible malignant cancer.
How are adrenal tumors diagnosed ?
A complete evaluation of the patient should start with a detailed history and thorough physical examination focusing on signs and symptoms of adrenal hyperfunction and malignancy.
- Hormonal Evaluation: Abnormalities of endocrine function have to be assessed. For adrenal cortical tumours, glucocorticoids have to be assessed (serum cortisol, levels of ACTH) and mineralocorticoids (serum potassium, serum aldosterone levels) have to be assessed. For adrenal medulla tumours, levels of catecholamines (adrenaline & noradrenaline) and their metabolites have to be assessed. This includes plasma-free metanephrines (best) & 24 hours urine analysis for catecholamines/metanephrines.
- Abdominal Sonography: It is a low-cost, non-invasive method which can detect adrenal masses that are larger than 2 cm in its greatest dimension. It cannot precisely delineate the size and morphologic characteristics of lesion.
- Computed Tomography: CT is the most effective technique for examining the adrenal glands. It allows the gland to be displayed clearly, and tumours as small as 10 mm in diameter are routinely identified with a sensitivity of up to 100%. Radiological evaluation by CT or MRI provides useful parameters to identify malignant lesions.
- Magnetic Resonance Imaging: MRI of adrenal masses gives anatomical details, tissue characterization and extension and invasion of adjacent structures.
- Radioisotope Scanning/Positron Emission Tomography: It utilizes radiotracers for locating and characterizing the adrenals by assessing the radioisotope uptake and accumulation. However, it needs experienced nuclear medicine centres.
- Positron Emission Tomography (PET): PET is a promising imaging modality in oncology. 2-[18F]-fluoro-2-deoxy-D-glucose PET rightly differentiated benign adrenal lesions that demonstrated zero uptake and adrenal metastases characterized by increased and high uptake.
How are adrenal tumors treated ?
The chief types of treatment that can be used for adrenal tumours include:
- Surgery
- Radiation
- Chemotherapy
Doctors on your cancer treatment team might include a surgeon, an endocrinologist, a radiation oncologist & a medical oncologist.
The majority of reports recommend that all functional adrenal tumors require treatment. If an adrenal lesion is managed minus surgery, then serial imaging studies should be undertaken, initially after 2 to 3 months of diagnosis and then at 6 months after diagnosis. If growth of the lesion is seen, then surgical intervention is indicated.
For primary adrenal cancer patients, open surgery is the first line of treatment. Surgery is indicated for masses that are larger than 5 cm in diameter or suspected of malignancy. The surgical approach consists basically of either open or laparoscopic adrenalectomy.
In general, malignant tumours have a poor prognosis when diagnosis is confirmed.
What is the care to be taken after the removal of an adrenal tumor ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans. Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
