Adrenal Gland Incidentaloma

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What are adrenal gland incidentalomas?

An adrenal gland incidentaloma is an unexpected adrenal gland tumour detected during imaging tests conducted for non-adrenal-related issues. Adrenal tumours (link to adrenal gland tumours service page) discovered during cancer evaluations are usually metastases (spread from other parts of the body) and are not categorised as incidentalomas. Due to the increased use and effectiveness of imaging technology and machines, more adrenal incidentalomas are being detected. The likelihood of having an adrenal gland incidentaloma rises as you age, up to 3% at 50 years old and 7% at 70 years old, respectively.

Adrenal incidentalomas are categorised into 3 main groups:

While many adrenal incidentalomas are harmless, further assessment is usually recommended because a small percentage can lead to significant health issues. ACE Specialist Surgery and Endoscopy provides comprehensive care and evaluation for adrenal incidentalomas to ensure your well-being.

What causes adrenal gland incidentalomas?

Adrenal gland incidentalomas, usually categorised as adrenal gland tumours (link to service page) or adrenal cancer, occur when genetic changes occur in the adrenal cells or other cells in the body, causing them to multiply uncontrollably, resulting in a growth or tumour. These genetic changes can turn on oncogenes – genes that help cells grow and divide or live longer, and turn off tumour suppressor genes – genes that reduce cell growth and tell cells when to die. Thus causing the overgrowth of cells.

However, it is still unclear as to what causes the DNA or genes of cells to malfunction. 

What are the symptoms of adrenal gland incidentalomas?

Even when adrenal tumours are discovered incidentally, they may cause various symptoms. The symptoms encountered depend on whether the tumour is functional or non-functional and if there is an overproduction of hormones.

Excessive cortisol results in:

  • Gaining weight or weight loss (especially around your face and abdomen)
  • Skin showing purplish stretch marks or bruising susceptibility
  • Muscle weakness
  • Emotional challenges like depression, anxiety, fatigue, and sleep disruptions
  • In women, the emergence of excess facial and body hair, acne, and irregular menstrual cycles
  • Elevated blood pressure
  • High blood sugar
  • Reduced bone density, rendering bones more fragile

Overproduction of aldosterone results in:

  • High blood pressure
  • Low blood potassium levels
  • Muscle weakness (rare/severe cases)

Overproduction of norepinephrine or epinephrine leads to:

  • Rapid or irregular heartbeats
  • Profuse sweating
  • Severe headaches
  • Tremors
  • Paleness
  • High blood pressure

High levels of androgens in women lead to:

  • Excessive facial and body hair
  • Male-pattern baldness
  • Acne
  • Irregular menstrual cycles

It is important to remember that individuals with non-functioning adrenal gland incidentalomas may not experience any of the symptoms mentioned above.

If you suspect you have symptoms of an adrenal gland incidentaloma or are concerned about your adrenal health, consult an endocrinologist for a proper evaluation and diagnosis.

Are adrenal gland incidentalomas painful?

Generally, adrenal gland incidentalomas are not painful. However, they can cause several symptoms if they are hormonally active. These symptoms may include weight changes, muscle weakness, high blood pressure, or other discomforts. If you are experiencing any discomfort, it is recommended to seek professional evaluation and care.

hypertension adrenal gland
Excess aldosterone can lead to high blood pressure as a symptom of adrenal gland incidentaloma.

Who is at risk of adrenal gland incidentalomas in Singapore?

In Singapore, anyone can be at risk of developing an adrenal gland incidentaloma. However, several factors increase the risk of developing adrenal gland incidentalomas. Risk factors of adrenal gland incidentalomas are:

While most incidentalomas are harmless, they require proper evaluation to rule out any underlying conditions.

How are adrenal gland incidentalomas diagnosed?

When diagnosing your adrenal gland incidentaloma, your endocrinologist (link to service page) will undertake a thorough assessment, which may involve:

  • Medical history review: gathering insights into your health background, including possible hereditary conditions and examining any signs or symptoms you may be experiencing.
  • Physical examination: this includes checking your vital signs such as blood pressure, pulse rate, and body weight.
  • Blood and urine tests: to measure adrenal hormones to determine whether the tumour is functional (produces hormones) or non-functional. Specialised tests may follow after obtaining the samples to assess your cortisol levels, including the dexamethasone-suppression test.
  • Genetic testing: in rare cases, genetic assessments may be necessary since hereditary conditions are one of the risk factors of adrenal gland incidentalomas.

If you have a family history concerning adrenal tumours and/or other types of tumours, high levels of calcium, kidney stones, high blood pressure, or any hormone-related issues, your endocrinologist may check for other factors; these include:

  • Adenoma
  • Adrenal gland cancer or metastasis from other parts of your body
  • Cysts located on or within your adrenal glands
  • Less common conditions, such as tumours that are filled with fat and blood cells

After compiling the necessary information, a comprehensive assessment can be done followed by an accurate diagnosis, guiding your endocrinologist to the appropriate treatment and care for your specific condition.

 laparascopy
Laparoscopic surgery is a minimally invasive procedure to remove adrenal gland incidentalomas.

What are the treatment options for adrenal gland incidentalomas in Singapore?

Treatment for adrenal gland incidentalomas varies and depends on the condition’s severity and the individual's overall health. Common treatment options for adrenal gland incidentalomas include: 

  • Evaluation and follow-up: a thorough assessment is conducted, followed by continuous monitoring of adrenal incidentalomas discovered during scans to ensure your well-being.
  • Hormonal work-up: if your tumour is hormonally active, a comprehensive hormonal work-up (link to adrenal gland disorders and surgery service page) is conducted. This treatment may include medications to regulate the overproduction of hormones, such as aldosterone antagonists, corticosteroids, alpha- and beta-blockers, and hormone replacement therapy (HRT).
  • Laparoscopic: this keyhole surgery (link to adrenal gland disorders and surgery service page) is usually done if your adrenal gland tumour must be removed. Its advantages include a quicker recovery time and minimal scarring, which returns you to optimal health faster.
  • Biopsy: in some cases, a biopsy may be conducted to determine the tumour's nature, whether benign or cancerous. This acts as a guide to decide which treatment is appropriate for you.

At ACE Surgery & Endoscopy, we are dedicated to providing you with the care you need and personalised treatment plans to address your unique needs. 

If you are suffering from an adrenal gland disorder, have a family history of adrenal disorders, or are concerned about developing adrenal cancer, schedule an appointment with ACE Surgery and Endoscopy for a detailed examination and individualised treatment plan. 

Frequently Asked Questions

Do all adrenal gland incidentalomas require treatment?

No, not all cases of adrenal gland incidentalomas require treatment. The necessity for treatment depends on factors such as the size of the tumour, production of hormone(s), and your symptoms.

What are the risks associated with adrenal gland incidentalomas?

Risks associated with adrenal gland incidentalomas include hormone imbalances, potential malignancy, and symptoms that impact your quality of life (in some cases).

Do I require surgery for adrenal gland incidentalomas?

Surgery is only required for tumour removal. The need for it depends on the size of your tumour, your hormone activity, and specific symptoms. Your endocrine surgeon  will recommend the most suitable course of action based in tumor size and appearance and patient condition and preference .

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Reyaz Moiz

Dr Reyaz Singaporewalla
Senior Consultant Endocrine and General Surgeon

MBBS (Bom), MS (Surg), DNB (Surg), FRCS (Edin), MMed (Singapore), FRCSEd.