Finding a tumour in an adrenal gland does not necessarily mean it needs to be removed. Two questions need to be answered first: does the growth produce excess hormones, and does it have features on imaging that raise suspicion of cancer? The decision to operate depends on these findings, along with symptoms, growth over time and general health.
These growths are often found on scans performed for another reason. Many are benign. However, having no pain does not mean that hormone activity is normal, so the initial assessment requires both imaging and appropriate tests.
What does an incidental finding on a report mean?
The adrenal glands sit above the kidneys and produce hormones involved in blood pressure, metabolism and the body's response to stress. A growth found here while investigating another condition is called an incidentaloma. The term describes how it was found. It does not tell us what type of tumour it is. The adrenal gland is a separate organ from the kidney itself.
A computed tomography scan, or CT scan, assesses more than the growth's diameter. It also looks at whether its internal structure is uniform, its density, its borders and its relationship to surrounding tissues. A CT scan taken without contrast may be enough to show that some growths are benign, but if the findings remain uncertain, further tests or a repeat scan after a set period may be needed.
Previous images allow comparison: rather than assessing the measurement in the new report in isolation, the doctor can check whether the growth has enlarged or changed in structure over time. An adrenal growth in someone who has had cancer in another organ is not automatically considered a sign of spread, but that history does affect the assessment.
Why are hormone tests important?
An endocrinologist, a specialist in hormones, determines which tests are needed. Excess production of different hormones causes different problems. Tests may be needed even without symptoms. Some changes can affect blood pressure, blood sugar and bones even when a person feels well.
Cortisol is involved in the body's response to stress and in metabolism. To investigate excess cortisol, a blood test may be taken after a dose of dexamethasone prescribed by the doctor; this test checks whether the hormone level falls as it should.
Excess production of adrenaline-related hormones is investigated by measuring substances called metanephrines in the blood or urine. When there are suspicious symptoms or imaging features that are not typical of a benign growth, this test is needed to assess how excess hormone production could affect both daily life and any potential procedure.
Aldosterone affects salt and fluid balance, and therefore blood pressure. If you have high blood pressure or an unexplained low potassium level, the ratio of aldosterone to a substance called renin may be checked.
Medicines you take and the conditions under which the test is performed need to be considered beforehand. Do not stop a medicine that could affect the result without medical advice. A result outside the normal range does not always mean surgery is needed; sometimes the test needs to be repeated or clarified with another investigation.
A tumour that produces excess adrenaline-like hormones is called a phaeochromocytoma. Episodes of palpitations, heavy sweating, headache and raised blood pressure may suggest this condition. Before surgery for this type of tumour, specific medication is needed to prepare the blood pressure and circulation. Operating without this preparation can cause serious changes in blood pressure.
Choosing between monitoring, biopsy and surgery
Surgery is often unnecessary for growths that look clearly benign on imaging, do not produce excess hormones and cause no symptoms. In some cases, further imaging follow-up is not needed either. For an indeterminate growth, the timing of repeat investigations and the changes that would prompt a review of the decision are agreed in advance.
Features suspicious for cancer, significant growth or excess hormone production causing clinical problems may be reasons for surgery. With mild cortisol excess, the decision is more individual. Blood pressure, diabetes, bone health, age and surgical risk are assessed together. A single size measurement cannot replace all this information.
A biopsy, which involves taking a tissue sample with a needle, is not the usual first step for an adrenal growth. It is considered only in specific circumstances where the result would change treatment. Phaeochromocytoma must be ruled out before a biopsy, because a procedure on this type of growth could trigger a dangerous release of hormones and a rise in blood pressure.
What is laparoscopic adrenalectomy?
Adrenalectomy is the removal of an adrenal gland. In laparoscopic surgery, the surgeon works with a camera and instruments inserted through small incisions. This approach can be used for suitable growths. If cancer is suspected to have spread into neighbouring tissues, open surgery may be more appropriate to remove the growth intact.
Bleeding, infection, injury to neighbouring organs and the possibility of switching to open surgery are among the risks discussed. The adrenal gland lies close to major blood vessels and other organs. Joint preparation by the endocrinologist, surgeon and anaesthetist, who keeps you asleep and monitors your vital signs during surgery, is an important part of treatment planning, particularly for hormone-producing tumours.
You can see the procedure in the laparoscopic left adrenalectomy video; it contains surgical footage intended for adults. Information about the approach is also available on the adrenal gland surgery page. The exact tissue diagnosis is established by laboratory examination after the growth has been removed.
How are hormones regulated after one gland is removed?
The remaining healthy adrenal gland can often meet the body's hormone needs, but temporary hormone replacement medication is sometimes needed, particularly after removal of a tumour that produced excess cortisol. If both glands are removed, lifelong hormone replacement medication is required. The duration of treatment is determined by test results and the endocrinologist's assessment.
If steroid replacement medication is prescribed, do not stop taking it without medical advice. You should be given a separate plan explaining what to do during illness or vomiting. Severe weakness, persistent vomiting, a drop in blood pressure and altered consciousness after surgery may indicate hormone deficiency and require emergency medical care.
Before surgery, a severe headache and very high blood pressure accompanied by chest pain, breathlessness or changes in vision also require emergency care. Follow-up after surgery includes checking the wound, blood pressure, hormone results and the laboratory report on the removed tumour. Your need for previous blood pressure medicines may change; new doses are determined under medical supervision.