Diagnosing Adrenal Tumors

If your NYU Langone doctor suspects you have an adrenal tumor, he or she may ask about your prior or existing health problems and your symptoms before performing any tests.

Most adrenal tumors are benign, meaning noncancerous. It is important to determine whether the tumor is functional, which means it produces elevated levels of hormones, or nonfunctional, which means it doesn’t.

Most functional tumors are benign, but even benign tumors often need to be removed because the elevated hormone levels can lead to hypertension, or high blood pressure; stroke; heart attack; weight gain; diabetes; and other health problems. A small percentage of adrenal tumors are malignant, or cancerous, and about half of all malignant tumors are functional.

Nonfunctional tumors can be either benign or malignant. Both types can grow large enough to compress nearby organs and may cause pain in the abdomen, side, or back.

Sometimes the results of a routine test—such as an imaging test your doctor ordered because you have high blood pressure that is not responding to medications—may reveal that you have an adrenal tumor. If your doctor suspects you have an adrenal tumor, or sees one on an imaging test, he or she may run a series of additional tests.

Blood and Urine Tests

Doctors may use blood or urine tests to check for abnormal levels of hormones in the body, which may be produced by adrenal tumors. Doctors can test some hormone levels in your blood. In some instances, doctors may need to test samples of your urine that are collected over a 24-hour period. This test can showdoctors how quickly your body is producing hormones.

Our doctors can also test for abnormal levels of potassium and the protein renin. The kidneys release renin when sodium levels are low. Abnormal levels of the hormone aldosterone, sodium, potassium, and renin may be signs of an aldosteronoma.

Your doctor may also test you for hormones like cortisol, which helps your body respond to stress. Elevated levels of cortisol may indicate the presence of Cushing’s syndrome. Elevated levels of other stress hormones, including dopamine, norepinephrine, and epinephrine, can be a sign of a pheochromocytoma.

Doctors can also test levels of adrenal androgens such as dehydroepiandrosterone, also known as DHEA, to determine whether an androgen-producing adrenal tumor may be present.

Imaging Tests

Although elevated levels of adrenal hormones may lead doctors to suspect that an adrenal tumor is present, imaging tests can confirm the diagnosis. Sometimes imaging tests are used when the only symptom of an adrenal tumor is pain in the abdomen, side, or back.

Often, imaging tests reveal adrenal tumors when a doctor is evaluating an unrelated condition. These tumors are called adrenal incidentalomas.

CT Scan

A CT scan is a form of X-ray that uses a computer to create cross-sectional, three-dimensional images of the adrenal glands. Before the scan, you may need to drink a liquid contrast agent and contrast dye may be injected into a vein to enhance the CT images. The contrast allows doctors to get a clear image of the adrenal glands.

MRI Scan

Another option for detecting adrenal tumors is an MRI scan. This imaging test uses a magnetic field and radio waves to create three-dimensional images of structures in your body. Before the scan, a contrast dye may be injected into a vein to enhance the MRI images.

PET Scan

Doctors at NYU Langone may use a PET scan to determine whether an adrenal tumor might be cancerous. If a person has a known cancer, doctors may also use a PET scan to determine whether it has spread or metastasized to the adrenal gland.

To perform a PET scan, your doctor injects a small amount of radioactive glucose, or sugar, into a vein. The glucose collects in highly active tissue—meaning the tissue is rapidly metabolizing, or processing the sugar. This tissue, including some cancers, is detected by a special camera. A computer then creates three-dimensional images of the tumor that tell doctors how active the tissue is.

Doctors are able to confirm whether a tumor is cancerous or benign after it is removed with surgery and examined under a microscope by a pathologist.

PET/CT Scan

If doctors need more detailed images of your adrenal glands, they may use a combined PET/CT scan to evaluate them. Whereas the CT portion of the scan uses X-rays to create cross-sectional images of the body, the PET scan detects how active a tumor is and whether it is more likely to be cancerous.

Adrenal Venous Sampling

When the body produces elevated levels of aldosterone, doctors may perform what’s known as adrenal venous sampling. This test helps doctors determine whether the high levels of aldosterone are coming from a single adrenal tumor, called an aldosteronoma, or a condition called bilateral adrenal hyperplasia, in which both adrenal glands are producing too much aldosterone.

To perform the test, doctors place a thin catheter, or hollow tube, into the vein in the thigh leading to both adrenal glands. They draw blood samples from both glands. Elevated levels from one gland suggest a tumor may be present, whereas elevated levels from both glands suggests that adrenal hyperplasia or another condition may be causing the problem.