Weill Cornell Medicine Urology
Weill Cornell Medicine Urology
Benign Lesions of the Adrenal Glands - Symptoms & Evaluation

Benign Lesions of the Adrenal Glands - Symptoms & Evaluation

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Incidental Tumor:

Most adrenal tumors do not produce hormones (non-functional) and are found incidentally on CT or MR imaging and therefore do not cause symptoms. An adrenal incidentaloma is found in up to 5% of all people who are undergoing imaging studies for another medical condition. Your physician will perform a history and physical examination for symptoms and signs of excessive hormonal production,  and order blood and urine tests to rule out overproduction of hormones by the incidentaloma.

Adrenal Cushing's Syndrome:

In adrenal Cushing's syndrome, excess cortisol is produced by adrenal gland tumors or hyperplastic adrenal glands.


Symptoms of Adrenal Cushing's Syndrome:

  • Weight gain and fat distribution mostly in the abdominal region
  • Easy bruising/thinning of the skin
  • Poor wound healing
  • Round face
  • Weak bones, which can lead to fractures
  • Fatigue
  • High blood pressure
  • High blood sugar
  • Irritability, anxiety, mood swings, and/or depression
  • Increased acne
  • Increased thirst and urination
  • Lack of menstrual periods/excessive facial hair in women

Evaluation of Adrenal Cushing's Syndrome:
Your physician will perform the following tests:

  • Review of all the medicines you are now taking; taking steroids for another medical condition such as arthritis, asthma, inflammatory diseases, and organ transplantation can cause Cushing's syndrome.
  • 24-hour urine evaluation
  • Blood tests
  • Radiographic tests such as CT or MR imaging to look for tumors on the adrenal or pituitary glands

Primary Hyperaldosteronism/Conn's Syndrome:

Conn's Syndrome occurs with the overproduction of the hormone aldosterone by the adrenal glands.


Signs and symptoms:
Most patients have no complaints, but have high blood pressure that does not respond to conventional treatment. In addition, low potassium is diagnosed on routine blood tests.


Other symptoms/signs may include:

  • Headaches
  • Excessive urination and thirst
  • Muscle weakness or cramps
  • Evaluation of Hyperaldosteronism
  • Your physician will perform the following tests:
    • Blood tests to check potassium, aldosterone, and renin levels
    • 24-hour urine examination
    • Radiographic tests such as CT or MR imaging to look for tumor on the adrenal gland
  • If the CT or MR images do not show a tumor because of its small size, but excessive aldosterone is being produced, you may have another test performed called adrenal venous sampling, where a radiologist will obtain blood samples directly from each adrenal gland to determine which adrenal gland (right or left) is the cause.

Pheochromocytoma:


Pheochromocytomas are tumors that cause overproduction of cathecholamine hormones, such as epinephrine and norepinephrine, that are involved in maintaining blood pressure. Excessive secretion of these hormones can cause very high blood pressure, heart palpitations, anxiety and sweating. Though a rare cause of high blood pressure, if left untreated, they can cause serious consequences, including heart attack, stroke, and arrthymia.


In most cases, a pheochromocytoma is a single, benign tumor that sporadically occurs in a patient without a family history of hormonal or endocrine problems. However, a small percentage may be linked to hereditary causes.


Signs and Symptoms:
Patients typically experience episodes of high blood pressure with associated:

  • Sweating
  • Headache
  • Heart palpitations
  • Anxiety
  • These may be brought on by exercise, emotional stress, or anesthesia, as well as increases in abdominal pressure during urination or defecation.

Evaluation of Pheochromocytoma:
Your physician will perform the following tests:

  • Blood tests to check cathecolamine levels
  • 24-hour urine examination to assess levels of these hormones in your urine
  • You will likely be asked to abstain from alcohol and caffeine intake 24 hours prior to the examinations
  • Radiographic tests such as CT or MR imaging to look for tumor on the adrenal gland

Metastasis of Primary Malignancy to the Adrenal Gland:


Although most adrenal lesions are benign non-functional adenomas, masses in patients with a known primary extra-adrenal malignancy require evaluation. The most common primary malignancies with adrenal metastases are carcinomas of the lung, breast, and melanoma. In general, metastatic lesions can be larger than benign adrenal adenomas and appear more heterogeneous and irregular on CT or MR imaging. In some cases, percutaneous biopsy may be recommended for definitive diagnosis

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Joseph J. Del Pizzo

M.D.

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