Adrenal Tumor Program

Symptoms: Usually are associated with the type of hormone that is overproduced.

• Cortisol (Cushing’s syndrome): weight gain especially in the abdomen, round face, increased blood pressure, increased blood glucose, insomnia, easy bruising and purple stretch marks
• Aldosterone (Conn’s syndrome): water retention and swelling, increased blood pressure, decreased potassium
• Testosterone: increased hair growth, voice deepening and male pattern baldness in women; weight gain

Diagnosis: Based on symptoms, the evaluation includes: 

• 24-hr urine collection and blood tests
• CT scan of the abdomen

Treatment: 

• All patients with functional adrenal tumors should undergo prompt surgical removal of the tumor by an expert surgeon, as their disease associated with hormone overproduction may progress rapidly.
• In the pre-surgical period, patients with functional adrenal tumors are managed by an endocrinologist using medical therapies to suppress the abnormal hormone levels.

Pheochromocytoma and paraganglioma are adrenal and extra-adrenal tumors, respectively, that secrets high amount of adrenaline. Approximately 35-40% of pheochromocytomas/paragangliomas are hereditary, and about 20-25% are malignant. 

Symptoms: Classic symptoms including headaches, sweating and racing heart beats as well as high blood pressure. Patients can also have anxiety, high blood sugar, dizziness or even no symptoms at all. 

Diagnosis: Based on symptoms, the evaluation includes: 

• 24-hr urine collection and blood tests
• CT scan or MRI and sometimes nuclear medicine imaging

Treatment: 

• Prior to surgical removal of a pheochromocytoma or paraganglioma, medical management with special blood pressure medications for 1-2 weeks is needed
• Surgical removal of the tumor by an expert surgeon is curative in the majority of patients
• Metastatic or recurrent pheochromocytomas are managed by a multidisciplinary team of oncologists, endocrinologists, endocrine surgeons and radiation oncologists

Adrenocortical carcinoma (ACC) is a rare cancer with an estimated 500 new cases annually is US. The majority of ACC are sporadic (non-hereditary and  there are few recently hereditary predisposition.

Symptoms: Initially the symptoms can be very subtle and adrenal cancer is often identified when tumor is large and causing back pain or abdominal pain by compressing structures in abdominal cavity.  Some tumors secrete hormones and cause patients to have associated symptoms: 

• Cortisol : weight gain especially abdomen, round face, increased blood pressure, increased blood glucose, insomnia, easy bruising
• Aldosterone: increased blood pressure, decreased potassium DHEA-S: increased weight and body hair in women

Diagnosis: Based on symptoms the evaluation includes: 

• Blood test to check the adrenal hormone levels
• Imaging to evaluate the tumor size and presence of metastasis

Treatment: 

• Resection by the expert surgeon remains the first line of treatment, however some tumors are unresectable
• Mitotane, a medicine that destroys the normal adrenal as well as cancer cells, is the main chemotherapeutic agent
• When many metastases are present, chemotherapy and occasionally radiation therapy are used