Diagnosis of Adrenal Cancer

Introduction

Adrenal cancer is a rare but serious condition that occurs when abnormal cells form in the adrenal glands small, triangular glands located above each kidney. These glands play a crucial role in producing hormones that regulate metabolism, blood pressure, immune response, and stress. Because adrenal cancer often grows quietly and symptoms may appear late, early and accurate diagnosis becomes essential for successful treatment. 

Understanding Adrenal Cancer and the Importance of Diagnosis

The adrenal glands consist of two main parts the adrenal cortex (outer layer) and the adrenal medulla (inner layer). Tumors can arise from either region, and they may be functional (hormone-producing) or non-functional. Functional tumors trigger hormonal imbalances, resulting in symptoms like high blood pressure, unexplained weight gain, excessive hair growth, or mood changes. Non-functional tumors may cause pain or discomfort only when they grow large.

Because many adrenal tumors are benign, incorporating accurate diagnostic steps is essential to differentiate harmless adenomas from adrenal cancer. Early detection significantly improves the chances of successful surgery and long-term survival.

Early Signs and Symptoms That Lead to Diagnosis

Before diagnostic tests are performed, doctors look for signs that might indicate adrenal cancer. Though symptoms vary depending on hormone production, some of the most common include

1. Persistent or severe high blood pressure
2. Unexplained weight gain or weight loss
3. Excessive body or facial hair (hirsutism)
4. Muscle weakness
5. Mood swings, anxiety, or depression
6. Abdominal pain or a feeling of fullness
7. Irregular menstrual cycles in women
8. Low potassium levels
9. Stretch marks on the abdomen or thighs
10. Fatigue and persistent tiredness

If these symptoms appear alongside abnormal hormone levels, doctors may suspect adrenal cancer and recommend imaging and laboratory tests.

Diagnosis of Adrenal Cancer

Diagnosing adrenal cancer involves a combination of clinical evaluation, blood and urine tests, imaging scans, and sometimes biopsy. The goal is to detect tumor size, assess hormone production, and determine whether the growth is malignant.

1. Hormonal Blood and Urine Tests :- Since many adrenal tumors produce excess hormones, one of the first steps in diagnosis is evaluating hormone levels. These tests help identify whether the tumor is functional and which hormones are affected.

Common hormonal tests include

1. Cortisol levels to check for Cushing’s syndrome
2. Aldosterone and renin ratio for diagnosing hyperaldosteronism
3. DHEA-S and testosterone levels to detect overproduction of androgen hormones
4. Estrogen levels in cases where tumors produce excess estrogen
5. Catecholamines and metanephrines for adrenal medulla–related tumors like pheochromocytoma
6. 24-hour urine test to measure fluctuating hormone levels over a full day

Abnormal results prompt further imaging tests to locate and evaluate adrenal tumors.

2. Imaging Tests :- Imaging plays a vital role in diagnosing adrenal cancer. Large tumors (typically more than 4–6 cm) are more likely to be malignant.

Key imaging tests include

• CT Scan (Computed Tomography) :- CT scans are considered the gold standard for adrenal tumor evaluation. They provide detailed images of adrenal gland structure, showing tumor size, density, shape, and possible spread to nearby organs.
• MRI (Magnetic Resonance Imaging) :- MRI is recommended for patients who cannot undergo CT scans or when doctors need clearer soft-tissue contrast. MRI is especially helpful in evaluating tumors suspected to involve blood vessels or surrounding tissues.
• PET Scan (Positron Emission Tomography) :- PET scans detect cancer activity by showing how fast cells absorb a radioactive tracer. Highly active tumors often indicate malignancy.
• Ultrasound :- While not typically used as the primary imaging method, abdominal ultrasound may detect larger adrenal masses.

3. Adrenal Venous Sampling (AVS) :- In cases where hormonal excess is detected, doctors may perform adrenal venous sampling, a specialized test that measures hormone levels directly from each adrenal vein. This helps identify which gland is overproducing hormones and guides treatment planning.
4. Biopsy :- Biopsy of the adrenal gland is rarely the first choice because there is a risk of spreading cancer cells or misdiagnosing certain tumors like pheochromocytoma. However, in cases where imaging is inconclusive or metastatic disease is suspected, a needle biopsy may be performed under CT or ultrasound guidance.

Biopsy results help determine whether the tumor is benign or malignant and guide therapy decisions.

5. Genetic Testing :- Some adrenal cancers are linked to inherited syndromes such as

• Li-Fraumeni syndrome
• Lynch syndrome
• Multiple endocrine neoplasia (MEN1)

If a patient has a family history of endocrine tumors or develops adrenal cancer at a young age, genetic testing may be recommended.

6. Staging the Cancer After Diagnosis :- Once adrenal cancer is confirmed, staging helps determine how far it has spread. The stages typically range from Stage I (localized small tumor) to Stage IV (cancer spread to distant organs).

Staging involves

• CT or MRI of the chest, abdomen, and pelvis
• PET scan to detect metastasis
• Blood tests to evaluate organ function

Accurate staging is crucial for treatment planning, which often includes surgery, chemotherapy, radiation therapy, or targeted therapy.

Why Early Diagnosis Matters

Adrenal cancer is aggressive, but early diagnosis dramatically improves treatment outcomes. Small, localized tumors have a much higher chance of being cured through surgery. Delaying diagnosis may allow the cancer to spread to vital organs such as the liver, lungs, or lymph nodes, complicating treatment.

Regular monitoring is especially important for individuals with

1. Hormonal imbalance symptoms
2. Family history of endocrine cancers
3. Known genetic disorders associated with adrenal tumors
4. Incidental adrenal masses detected during imaging for other conditions

Conclusion

Diagnosing adrenal cancer involves a systematic approach, starting with hormonal tests, followed by advanced imaging, and sometimes biopsy or genetic testing. Early detection plays a crucial role in improving survival and treatment success. If you experience unexplained hormonal symptoms, persistent abdominal discomfort, or changes in blood pressure, consult an endocrinologist or oncologist promptly. Timely evaluation can make a significant difference in managing adrenal cancer effectively.