Definition and Overview
Neoplasm (abnormal growth of tissue) of adrenal gland refers to a group of diverse and complex benign and malignant adrenal tumours. The adrenal glands are part of the endocrine system found at the top of each kidney. They release different hormones into the bloodstream that enable tissues to function properly.
Some of the most important hormones released by the adrenal glands are aldosterone, cortisol, and androgen. They regulate salt and water in the body as well as metabolism, help control blood sugar levels, assist with memory formulation, help reduce inflammation, and play a crucial role in a person’s reproductive and sexual function.
An adrenal gland tumour develops when healthy cells change and grow out of control. The growth can be cancerous (malignant neoplasm of adrenal glands) or non-cancerous (benign neoplasm of adrenal glands). It can also be functioning or non-functioning. Functioning tumours may produce any hormone in the adrenal gland. If they produce too much hormone, the patient will experience symptoms. For example, if too much cortisol is produced, patients may feel overly stressed and fatigued. They can also gain weight despite working out frequently or watching their diet carefully.
The tumour can grow in any of the adrenal glands’ two main parts: medulla and cortex. Medulla is the inner part of the gland and is responsible for the production of stress hormones (adrenaline and noradrenaline). Adrenal cortex, on the other hand, is the outer part that produces hormones that maintain the salt balance in the body (mineralocorticoid), regulate metabolism (glucocorticoids), and those that play a part in the use of protein, carbohydrates, and fats.
Primary types of neoplasm of adrenal glands
Adrenal adenoma – This is a non-cancerous adrenal mass that does not usually cause symptoms (asymptomatic). However, some adrenal adenomas are functioning tumours and can produce high levels of hormones leading to different medical conditions including Cushing’s syndrome and primary aldosteronism.
Pheochromocytoma – Usually develops in the medulla, this tumour secretes catecholamine hormones and results in various symptoms including high blood pressure, fast heartbeat, sweating, and recurrent headaches. 10% of pheochromocytoma cases are cancerous and are treated with surgery.
Neuroblastoma – This tumour commonly occurs in children age five or younger. However, it can also develop in older children but such cases are extremely rare. Its symptoms include abdominal pain, the presence of mass under the skin, and changes in bowel habits.
Adrenocortical carcinoma – This type of tumour is extremely rare but when it develops, it has a greater tendency to spread (metastasize) to other parts of the body.
Causes of the Condition
Just like other types of cancer, the definitive cause of cancerous adrenal gland tumours is unknown. What is known, however, is that they form when healthy cells in the adrenal gland start to grow out of control and form a mass.
Although the exact causes of the condition are yet to be established, doctors have identified factors that can increase one’s risk of developing the condition. These include having certain hereditary conditions such as:
Multiple endocrine neoplasia
Von Hippel-Lindau syndrome
Patients with a family history of the condition are encouraged to undergo tests and get assessed by a genetic counselor. This may help in catching the condition in its early stages when it is most responsive to simple treatments.
Patients with an adrenal tumour may or may not experience symptoms. This depends on whether or not the tumour is functioning or non-functioning and if it is cancerous or benign. It also depends on which hormone is affected. These symptoms include:
Change in libido
Excessive hair growth
High blood pressure
Low potassium level
Unexplained weight gain
Who to See and Types of Treatments Available
Neoplasm of the adrenal gland is diagnosed using a variety of tests. These include urine and blood tests that help doctors determine whether the tumour is functional or non-functional. Functional tumours release certain substances that can be detected with these tests.
Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans are also performed so doctors can evaluate if the tumour is malignant or cancerous. For cancerous tumours, the said imaging tests can also be used to determine the stage of cancer and whether or not the cancerous cells have spread to other parts of the body.
Patients with adrenal gland tumours are treated by a multidisciplinary team of doctors who work together to create the patient’s overall treatment plan. This team typically includes endocrinologists, nuclear medicine physicians, surgeons, and medical and radiation oncologists. For patients with cancerous tumours, their medical team may also include pharmacists, dietitians, counselors, and oncology nurses.
When formulating the best treatment plan for the patient, doctors consider various factors including the type of tumour (benign or malignant), the stage of cancer, the patient’s overall health condition and preferences, and possible side effects of the chosen treatment.
Neoplasm of the adrenal gland is treated with a surgical procedure called adrenalectomy, which removes the tumour and a small portion of surrounding healthy tissue. The surgery can be performed using traditional method (open surgery) or minimally invasive technique (laparoscopic) if the tumour is smaller than 5cm. This is the preferred option because it is safer and with minimal risks compared to traditional surgery. It minimises bleeding, the risk of scarring, and pain during surgery and recovery. In this procedure, several small incisions are made (either in the abdomen or back) where a small camera (laparoscope) and special tools are inserted. Patients who undergo laparoscopic surgery have to stay in the hospital for one to three days for close monitoring but they are able to resume daily activities within a week. Meanwhile, those with larger incisions are typically hospitalised for up to seven days and are not allowed to lift heavy objects for up to six weeks after the surgery.
Patients with cancerous tumours removed have to undergo chemotherapy or radiation therapy following their surgery to kill remaining cancer cells. Chemotherapy is administered by a medical oncologist and involves the use of drugs to stop cancerous cells from growing and dividing. The medicine can be delivered intravenously or orally. Patients who undergo chemotherapy experience various side effects including loss of appetite, hair loss, fatigue, and diarrhea. Their risk of developing an infection is also increased.
Radiation therapy, on the other hand, uses high-energy x-rays to kill tumour cells and is administered by a radiation oncologist. Patients with adrenal gland tumours can undergo external-beam radiation therapy in which radiation is given from a machine outside the body. Just like chemotherapy, this form of treatment also has side effects including fatigue, upset stomach, and loose bowel movements.
Wilson JS, et al. A systematic review of 131I-meta iodobenzylguanidine molecular radiotherapy for neuroblastoma. European Journal of Cancer. 2014;50:801.
Radiation therapy for neuroblastoma. American Cancer Society. http://www.cancer.org/cancer/neuroblastoma/detailedguide/neuroblastoma-treating-radiation-therapy. Accessed Nov. 11, 2015.