What Is Adrenal Adenoma

Adrenal adenoma refers to the non-cancerous (benign) tumor that develops in the adrenal cortex, the outer layer of the adrenal gland. These adrenal glands are present on the top of both the kidneys. There can be multiple tumors in the adrenal cortex, which are collectively called as adrenal adenomas.

The main function of the adrenal cortex is generally to generate hormones that are a part of the steroid collection. An adrenal adenoma is said to be ‘functioning’ when it generates the hormones. Although this means that the adenomas are in a good state, in fact, they often end up generating too much quantity of steroid hormones. On the other hand, if an adrenal adenoma is unable to generate the steroid hormones, it is said to be ‘non-functioning’.

The presence of adrenal adenomas is detected just by chance during a scan of the body, which is actually meant for checking some other medical condition. If they are present, it calls for a through assessment to know about their nature and functions, especially to find out whether they are generating hormones or not. This is because adrenal adenoma that is producing steroid hormones can drive the patient to suffer from really serious consequences if not treated with care.

Adenoma versus Other Tumors or Masses in the Adrenal Gland

A mass in the adrenal gland is usually cancer whose origin lies in some other part of the body, for instance, the lungs or bowel. This is also known as the ‘metastatic’ cancer. The origin of the cancer is known through some clinical assessment or from straightforward tests such as X-ray. Further, the CT or MRI scan of the metastatic cancer in the adrenal gland is different from a benign adrenal adenoma and can be distinguished through the use of specialized radiology.

In addition, a mass in the adrenal gland can be a rare cancer of the adrenal cortex (adrenocortical carcinoma). These cancers are huge enough and are capable of generating a mixture of hormones.

An adrenal mass can origin even from the adrenal medulla, which forms the inner part of the adrenal gland. The adrenal medulla is related to the nervous system and is the producer of the two hormones namely, adrenaline and noradrenaline. The tumors that develop from the adrenal medulla are known as phaeochromocytomas and they are different from the adenomas. It is possible to distinguish between the adenomas and phaeochromocytomas by using specialized scanning techniques along with the blood and urine tests to check adrenaline and noradrenaline.

Causes of Adrenal Adenoma

Even until today, the experts are unable to identify the precise cause of adrenal adenoma. The generally accepted beliefs about the causes of adrenal adenomas are listed below.

• Is mostly due to some particular genes (not yet known) in which alteration (mutation) has taken place.
• Mostly occur along with a few inherited diseases such as Carney complex, multiple endocrine neoplasia type I, and the Beckwith-Wiedemann syndrome. However, many cases of adrenal adenomas have nothing to do with an inherited disease.
• Mostly occur in patients having genetic problems in the various systems of the body that produce steroid hormones. For example, a patient with congenital adrenal hyperplasia along with poor control is more likely to develop adrenal adenomas.

As the age increases, the probability of developing an adenoma also increases. According to a research, benign adrenal adenomas take place in approximately 1 to 32 percent of the population suffering from autopsy. Among these, only 5 percent of them are diagnosed with adrenal adenomas. The further studies on this topic have revealed that approximately 6 percent of the patients who are above 60 years develop an adrenal adenoma.

In a nutshell, there are no other factors have been identified as the cause of benign adrenal adenoma and defined and that there is no way to prevent these tumors.

Symptoms of Adrenal Adenoma

Generally, patients with an adrenal adenoma do not exhibit any symptom of the adenoma. But, according to the survey, even in patients who do not show any symptom, many adrenal adenomas do generate excess quantity of steroid hormones. This can lead to many abnormalities that are responsible for apparent symptoms. Listed below are the abnormalities and their symptoms.

• Excessive Cortisol:
  This is the most common one, which is a steroid hormone that plays its role in reacting to stress and energy balance. Its too much production leads to Cushing’s syndrome, which is one of the symptoms of the adrenal adenomas.
• Excessive Aldosterone:
  This leads to Conn’s syndrome.
• Excessive Male Steroids:
  This leads to acne and hair growth.

Other rare symptoms of adrenal adenomas include bleeding into adenomas and pain at the sides or back.

Diagnosis

In most cases, the adrenal adenomas are spotted just by chance at the time of abdominal Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan done for verifying some other symptoms.

According to the medical research, CT scanning detects these adrenal masses or lumps approximately in 0.3 to 11 percent of the population. Among these people, approximately 80 percent of them are found to have a benign non-functioning adrenal adenoma.

Doctor’s Steps towards the Treatment

An endocrinologist is a medical expert who can detect the presence of adrenal adenoma and its symptoms. The detection of adrenal adenomas or masses requires specialized scans and hormone assessments. Therefore, an endocrinologist would perform the listed below assessments or tests.

• Looking for indicators of the Cushing’s syndrome, Conn’s syndrome, acne, and hair growth
• Checking the blood pressure
• Examining generally to look for the growth of tumors anywhere else
• Performing additional scans such as a chest X-ray and an MRI scan of the adrenal glands, if required
• Taking specialized tests to detect the different hormones’ levels

Following are the specialized tests that are taken by the endocrinologist.

• A 24-hour urine collection to check adrenaline and noradrenaline
• Blood tests for:
  • Potassium, which is a type of salt whose level is managed by the hormones of the adrenal gland.
  • Renin and aldosterone levels – these are hormones that play a role in controlling blood pressure. The level of renin is determined by lying down as it is affected by the posture.
  • Male sex hormones – testosterone, 17-hydroxyprogesterone, dihydroepiandrostenedione, and androstenedione.
  • Female sex hormones – oestradiol and progesterone.
• A ‘low-dose dexamethasone suppression test’ for checking the control of the body towards cortisol secretion

In low-dose dexamethasone suppression test, the dexamethasone drug, which is a synthetic steroid, is given orally and then blood is taken for testing the cortisol levels. In general, due to the extra dose of dexamethasone dose, the production amount of the cortisol would decrease in the body as the sign of reaction of the dose. However, even in this situation, the adrenal adenoma would continue to produce cortisol despite the dexamethasone dose.

If any victim is taking the oral contraceptive pill, she will be asked to avoid it for six weeks prior to any blood tests. This is because the female sex hormones in the pill make it tough to detect the blood levels of steroid hormones.

Treatment of Adrenal Adenoma

If you think that diet and lifestyle can help in the treatment, there is no such evidence to support your thinking.

The most appropriate treatment of a functioning adrenal adenoma is adrenalectomy, which refers to the standard surgery wherein the affected part of the adrenal gland is eradicated. At some hospitals, a laparoscopic (keyhole) adrenalectomy is also available for the victims of the adenomas. However, there is no evidence that shows the goodness of this surgery over and above the standard one. Listed below are the other treatments based on some characteristics of the adrenal lumps (lump is a swelling-like part that might lead to cancer later).

• Any adrenal lump, when detected with the MRI scan, might have uncertain characteristics such as its size being larger than 3 cm or any sign of bleeding or degeneration. Such a lump should be eradicated through surgery to reduce the chances of adrenal cancer to zero.
• Adrenal lumps that are unable to generate hormones, are less than 3 cm, and might seem like a benign cortical adenoma needs supervision by yearly scanning to make sure that no abnormal changes are taking place.
• The metyrapone (Metopirone) drug controls the production of cortisol by the adenoma and can prevent it for six weeks to let the tissues to pick up from the Cushing’s syndrome.

Risks with the Treatment

The risks that are associated with the abdominal surgery and the threats of having an anaesthetic are also linked with the surgery of the adrenal gland.

In addition, during the operation, the spleen that exists below the left lung in the stomach also needs to be removed in rare cases. Sometimes, even the left adrenal gland has to be removed to avoid future hazards.

The spleen is actually responsible for protecting the body against specific bacterial infections. On its removal or of the left adrenal gland, the doctors vaccinate such patients against two critical bacteria namely the:

• Pneumococci that is the cause of lobar pneumonia
• Meningococci that is the cause of bacterial meningitis)

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