Leonardo Rojas

Adrenal glands tumours tend to be very small, especially the benign ones the malignant ones tend to be large, that is how we differentiate between benign and malignant tumours so typically a tumor more than 5 or 6 cms in size has to be considered malignant unless otherwise proven, so we need to excise the tumour. But smaller size tumours can be left alone and very often these benign adrenal tumours are recognized incidentally. So when you go for a scan for some other reason, that is unrelated to the Adrenal gland, you may find out on an ultrasound or a CT scan that there is a small tumor. So this is called as an incidnetalomas. So typically a benign adrenal tumours are asymptomatic, that is what you have to keep in mind, whatever symptom you may get may not be related to the adrenal gland tumour itself. You need to see if your adrenal gland tumour is giving you any trouble, you need to look at your blood pressure and if it is easy to control the blood pressure because blood pressure can be elevated even without adrenal gland tumour. Most people who have high blood pressure do not have adrenal gland tumour. But is your blood pressure difficult to control. If it this is difficult to control with multiple drugs then the tumor could be responsible for your blood pressure and we need to look at this carefully. Do you have features of Cushing’s syndrome? Cushing’s syndrome can be diagnosed easily by your endocrinologist by just looking at you. So if there is a good index of suspicion, we do a test called as the screening test. The usual screening test that we do is a 24 hour collection for cortisol or we do an overnight dexamethasone suppression test, by these tests we come to know whether you have cortisol excess. If you have cortisol excess, you will have all the symptoms of Cushing’s syndrome like rounding of face outing on weight in the belly, having stretch marks in your skin, thinning out of skin, weak bones fractures, all these can be features of adrenal tumors which are benign. But if any adrenal tumors are producing symptoms, they need to be removed. If any adrenal tumor is producing symptom unrelated to it, then probably removing it may to help it. So typically the link between the symptom and the adrenal tumour is a difficult one to make. It is best left to a specialist. It is best to visit an endocrinologist if you have a benign adrenal tumour that has been discovered.

Postdoctoral fellow, Katie Basham shares the research being done around adrenal cortical carcinoma to find better treatment options.

Matthew Campbell, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the potential role of immunotherapy in treating adrenocortical carcinoma. Combining immunotherapy with targeted therapies has demonstrated promising efficacy in kidney and thyroid cancer, and clinical trials investigating mitotane and pembrolizumab in adrenocortical carcinoma are currently underway. This interview took place at the European Society for Medical Oncology (ESMO) 2022 Congress in Paris, France.

Adrenal specimens are an infrequent but often challenging spectrum of tumors where the determination of malignant potential could be especially a challenge. This simplified diagnostic approach outlines comprehensive yet easy-to-follow guidelines.

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Chapters

0:00 Introduction
0:51 Causes of Benign adrenal tumors
1:30 Symptoms of Benign adrenal tumors
2:20 Diagnosis of Benign adrenal tumors
2:42 Treatment of Benign adrenal tumors

An adrenal tumor or adrenal mass[2] is any benign or malignant neoplasms of the adrenal gland, several of which are notable for their tendency to overproduce endocrine hormones. Adrenal cancer is the presence of malignant adrenal tumors, and includes neuroblastoma, adrenocortical carcinoma and some adrenal pheochromocytomas. Most adrenal pheochromocytomas and all adrenocortical adenomas are benign tumors, which do not metastasize or invade nearby tissues, but may cause significant health problems by unbalancing hormones. Metastasis to one or both adrenal glands is the most common form of malignant adrenal lesion, and the second most common adrenal tumor after benign adenomas.[4] Primary tumors in such cases are most commonly from lung cancer (39%), breast cancer (35%), malignant melanoma, gastrointestinal tract cancer, pancreas cancer, and renal cancer.[4]
Tumors of the adrenal cortex

The adrenal cortex is composed of three distinct layers of endocrine cells which produce critical steroid hormones. These include the glucocorticoids which are critical for regulation of blood sugar and the immune system, as well as response to physiological stress, the mineralcorticoid aldosterone, which regulates blood pressure and kidney function, and certain sex hormones. Both benign and malignant tumors of the adrenal cortex may produce steroid hormones, with important clinical consequences.[citation needed]
Adrenocortical adenomas are benign tumors of the adrenal cortex which are extremely common (present in 1-10% of persons at autopsy). They should not be confused with adrenocortical "nodules", which are not true neoplasms. Adrenocortical adenomas are uncommon in patients younger than 30 years old, and have equal incidence in both sexes.[citation needed] The clinical significance of these neoplasms is twofold. First, they have been detected as incidental findings with increasing frequency in recent years, due to the increasing use of CT scans and magnetic resonance imaging in a variety of medical settings. This can result in expensive additional testing and invasive procedures to rule out the slight possibility of an early adrenocortical carcinoma. Second, a minority (about 15%) of adrenocortical adenomas are "functional", meaning that they produce glucocorticoids, mineralcorticoids, and/or sex steroids, resulting in endocrine disorders such as Cushing's syndrome, Conn's syndrome (hyperaldosteronism), virilization of females, or feminization of males. Functional adrenocortical adenomas are surgically curable.[citation needed]

Most of the adrenocortical adenomas are less than 2 cm in greatest dimension and less than 50 gram in weight. However, size and weight of the adrenal cortical tumors are no longer considered to be a reliable sign of benignity or malignancy. Grossly, adrenocortical adenomas are encapsulated, well-circumscribed, solitary tumors with solid, homogeneous yellow-cut surface. Necrosis and hemorrhage are rare findings.[citation needed]