Adrenal Mass/Adrenal Cancer

General

Adrenal masses are commonly found on imaging studies performed for other reasons (i.e. incidental adrenal mass).

Adrenal masses are first evaluated to determine the risk of neoplasm (i.e. cancer) and secondarily are evaluated to determine if they are functional (i.e. do they produce hormones).

Types

  • Adrenocortical carcinoma
  • Non-functional adrenal adenoma
  • Functioning adenoma
    • Causing Cushing’s syndrome, hyperaldosteronism, virilization or feminization
  • Angiomyolipoma
  • Pheochromocytoma
  • Adrenal metastasis
  • Adrenal hyperplasia
  • Cyst
  • Hematoma
  • other

Risk Factors

  • Can be associated with hereditary syndromes, but the majority are non-hereditary.
  • Children under 5 or adults between 40-50 years of age
  • Female gender
  • arsenic exposure
  • Phenacetin use
  • Chinese Herb Nephropathy

Staging (TNM)

Primary Tumor (T):

  • TX-primary tumor cannot be assessed
  • T0-No evidence of primary tumor
  • T1-Tumor ≤5cm in greatest dimension, no extra-adrenal invasion
  • T2-Tumor >5cm, no extra-adrenal invasion
  • T3-Tumor of any size with local invasion, but not invading adjacent organs
  • T4-Tumor of any size with invasion of adjacent organs

Regional Lymph Nodes (N):

  • Nx-Lymph nodes cannot be assessed
  • N0-no lymph node metastasis
  • N1-Metastasis in regional lymph nodes.

Distant Metastasis (M):

  • M0-No distant metastasis
  • M1-Distant metastasis

Evaluation

  • Laboratory tests to test for functionality of the tumor
  • Physical exam for findings of hormonal excess
  • Imaging: CT, MRI, ultrasound, PET scan
  • Biopsy may be indicated in certain lesions when there is a concern for potential metastasis from another type of cancer. Pheochromocytoma must be ruled out prior.

Treatment Options

  • Adrenal masses are treated based on the primary diagnosis.
  • Adrenocortical carcinomas and most functional tumors are treated surgically with adrenalectomy via an open, laparoscopic, or robotic-assisted laparoscopic technique.
  • Tumors that are not thought to be cancer and which are non-functional may be observed with regular exam, labs, and imaging.

Recommended Follow-up

Depends upon the primary diagnosis of the mass and the treatment recommended.