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Adrenal glands are small organs located on top of the kidneys in the lower back. Each gland consists of an inner and an outer section, which produce different hormones needed for your body to function.
The hormones produced by the outer section, called the cortex, include aldosterone, which regulates blood pressure; androgens, which are male sex hormones; and cortisol, which helps your body respond to stress. The hormones produced by the inner section—called the medulla—include epinephrine and norepinephrine, which also regulate blood pressure.
Tumors on the adrenal glands can cause the glands to produce elevated levels of hormones, which may result in high blood pressure, rapid heart rate, headache, sweating, easy bruising, fatigue, fluid retention, and low levels of potassium, a mineral important for heart health. Most adrenal gland tumors are benign, meaning noncancerous, but they need to be treated if they cause symptoms.
The causes of adrenal tumors are not fully understood, although some rare genetic conditions increase the risk. These include multiple endocrine neoplasia type 2, von Hippel–Lindau syndrome, familial paraganglioma syndrome, neurofibromatosis type 1, Carney complex, and Li–Fraumeni syndrome.
There are several types of adrenal tumors that may require treatment.
Tumors that develop in the outer part of the adrenal gland, or cortex, can lead to Cushing’s syndrome, in which too much of the adrenal hormone cortisol is produced. Symptoms include rapid weight gain—especially in the trunk and face, without weight gain in the arms and legs—growth of fat pads along the back, which are often referred to as a “buffalo hump,” and fat pads on the face, creating what’s known as a “moon face.”
Symptoms also include thinning skin that’s easily injured, purple stretch marks on the thighs and abdomen, increased hair growth on the face, moodiness or irritability, and muscle weakness.
An aldosteronoma is usually a noncancerous, or benign, tumor that occurs on the outer part of the adrenal gland. Tumors like this cause the gland to produce elevated levels of the hormone aldosterone. This can lead to a condition known as Conn’s syndrome, in which the body retains sodium and water, resulting in bloating and severe high blood pressure.
Conn’s syndrome can also lead to low levels of potassium, an essential element in the body. Left untreated, high blood pressure from Conn’s syndrome can put you at risk for stroke, heart attack, or kidney failure.
A pheochromocytoma is a rare tumor that usually starts in the adrenal medulla—the inner section of the adrenal gland, which normally produces healthy levels of stress hormones. These types of tumors cause the adrenal medulla to produce elevated levels of stress hormones, including dopamine, norepinephrine, and epinephrine. This can lead to very high blood pressure, stroke, heart attack, and even death.
A small number of these tumors are malignant, or cancerous.
Sex Hormone–Producing Tumors
Although rare, some adrenal tumors secrete androgen and other hormones that control male sex characteristics. Symptoms of androgen-producing tumors in boys include the early onset of puberty. In girls and women, excess androgen production can lead to deepening of the voice, acne, and excessive hair growth.
These tumors are more likely to be malignant, meaning cancerous, than other adrenal tumors. Tumors that secrete both androgen and additional adrenal hormones are also more likely to be malignant. Malignant tumors may spread to other parts of the body, such as nearby abdominal organs or lymph nodes.
Adrenocortical carcinoma is a rare condition in which malignant, or cancerous, cells form in the outer section of the adrenal gland called the cortex. This type of cancer tends to be aggressive, meaning it grows rapidly, and may spread to other parts of the body.
Fast-growing tumors sometimes cause the adrenal gland to produce elevated levels of aldosterone, cortisol, and adrenal sex hormones such as androgen. Symptoms of adrenocortical carcinoma—such as high blood pressure, weight gain, and diabetes—can easily be attributed to or confused with many other medical problems. Pain in the abdomen, side, or back may be one of the first symptoms of adrenocortical carcinoma that prompts a visit to the doctor.
Metastasis to the Adrenal Gland
Adrenal incidentaloma is the term given to adrenal tumors that are found incidentally on imaging tests ordered for other medical conditions. More than 90 percent of incidentally discovered adrenal tumors are benign, but they must all be investigated further. They may be any one of the types of adrenal tumors.
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