Adrenal Tumours
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Adrenal tumours are abnormal growths in the adrenal glands, which can be benign (adenomas) or malignant. These tumours may be functional (hormone secreting) or non functional.
Aetiology
- Adrenocortical adenomas: benign tumours that may secrete cortisol (Cushing’s syndrome) or aldosterone (Conn’s syndrome).
- Phaeochromocytomas: catecholamine-secreting tumours arising from adrenal medulla.
- Adrenocortical carcinomas: rare but aggressive malignancies.
- Metastatic disease: secondary tumours from lung, breast, or renal cancers.
Pathophysiology
- Adrenal cortex tumours can cause hormone overproduction, leading to hypercortisolism (Cushing’s syndrome) or hyperaldosteronism (Conn’s syndrome).
- Phaeochromocytomas lead to excess catecholamine production, causing episodic hypertension, palpitations, and diaphoresis.
- Non-functional tumours may grow significantly before causing compressive symptoms.
Risk Factors
- Genetic syndromes (e.g., MEN2, von Hippel-Lindau, Li-Fraumeni syndrome).
- Family history of adrenal disorders.
- Hypertension and endocrine syndromes.
- Previous malignancies with metastatic potential.
Signs and Symptoms
- Functional tumours:
- Cushing’s syndrome: central obesity, moon face, striae, hypertension.
- Conn’s syndrome: hypertension, hypokalaemia, metabolic alkalosis.
- Phaeochromocytoma: episodic headaches, sweating, tachycardia, hypertension.
- Non-functional tumours:
- Asymptomatic or discovered incidentally on imaging.
- Abdominal pain or mass effect in larger tumours.
Investigations
- Serum cortisol and ACTH: for suspected Cushing’s syndrome.
- Genetic testing: for patients with a family history of the disease.
- 24hr urine hormone test: for suspected phaeochromocytoma (these tests are done in secondary care).
- CT/MRI adrenal imaging: to assess tumour size and characteristics.
Management (mainly secondary care, in primary care refer to endocrinology)
Note: The following information is for awareness only, as management is carried out by a specialist/MDT.1. Medical Management:
- Phaeochromocytoma: alpha-blockade (e.g., phenoxybenzamine) followed by beta-blockade before surgery.
- Cushing’s syndrome: steroidogenesis inhibitors (e.g., metyrapone, ketoconazole).
- Conn’s syndrome: mineralocorticoid receptor antagonists (e.g., spironolactone).
2. Surgical Management:
- Adrenalectomy: indicated for functional tumours or suspected malignancy.
- Minimally invasive (laparoscopic) or open surgery depending on tumour size.
3. Radiotherapy and Chemotherapy:
- Used in adrenal cortical carcinoma or metastatic adrenal tumours.