Adrenal Gland Tumours

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What are adrenal gland tumours?

Adrenal gland tumours, sometimes known simply as adrenal tumours, are growths that develop in one or both of your adrenal glands (a small triangular-shaped gland above each kidney). The adrenal glands play an important role in your body and are responsible for producing and releasing hormones for bodily functions such as metabolism, sexual development, stress responses, and more.

malignant tumour
adrenal medulla tumours are malignant

Adrenal tumours can either be benign (non-cancerous) or malignant (cancerous), and they can either be functioning or non-functioning. Functioning adrenal tumours indicate that the tumour is producing hormones, while a non-functioning tumour indicates that the tumour is not producing any hormones. 

Most adrenal gland tumours are benign but are still capable of producing one or more adrenal hormones, resulting in various symptoms.

adrenal gland
your adrenal glands are composed of several parts

What causes adrenal gland tumours?

Adrenal gland tumours occur when genetic changes occur in the adrenal cells, 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. Several risk factors may contribute to this occurrence; these include being over the age of 40 with specific hereditary conditions such as Lynch syndrome, Carney complex, Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, and multiple endocrine neoplasia type 1 (MEN 1).

What are the symptoms of adrenal gland tumours?

Symptoms of adrenal gland tumours usually depend on whether the tumour is functioning or non-functioning and, if the tumour is functioning, which hormone is being overproduced. General symptoms of adrenal gland tumours include: 

  • High blood pressure/hypertension
  • Abdominal pain
  • Stretch marks on your abdomen
  • Low levels of potassium
  • Heart palpitations
  • Nervousness
  • Feelings of anxiety/panic attacks
  • Headaches
  • Fatigue
  • Acne
  • Heavy perspiration (sweating)
  • Diabetes
  • Unintended weight gain/loss
  • Excessive hair growth
  • Changes in your genitals
  • Changes in your libido (sex drive)
  • Changes in your menstrual cycle

It is important to remember that individuals with benign, non-functioning adrenal gland tumours may not experience any of the symptoms stated above.

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

Are adrenal gland tumours painful?

Not all adrenal tumours are painful. Some adrenal tumours, especially those that overproduce hormones (active), can lead to symptoms such as abdominal pain, headaches, and discomfort. Additionally, large tumours may press on nearby organs, which can potentially cause pain and a feeling of fullness in your abdomen.

Who is at risk of adrenal gland tumours in Singapore?

Generally, while adrenal gland tumours are rare, they can affect anyone, with some individuals having a higher predisposition than others. Risk factors of adrenal gland tumours include:

If you are experiencing symptoms of adrenal gland tumours or are concerned about your risk of developing it, make an appointment with ACE Specialist Surgery and Endoscopy to get proper medical assessments for early detection.

How are adrenal gland tumours diagnosed?

Several tests can be used to diagnose adrenal gland tumours. It is unlikely that all of the methods mentioned will be used for each individual as the following factors will be considered; these are:

  • The type of tumour(s)
  • Your unique signs and symptoms
  • Your age and overall health
  • Results from previous medical tests (if any)

Depending on certain factors, your endocrinologist (link to about us) may conduct one or more of the following tests:

  • 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.
  • Biopsy: Pre-operative biopsies of adrenal masses is not routinely recommended. Rarely it image guided needle biopsies are performed in hte setting of patients with cancer to confirm or rule out adrenal metastases. Before any such biopsies, pheochromocytoma needs to be excluded. Primary adrenal tumors cannot be differentiated as benign or malignant on needle biopsies and complete surgical removal is the only definitive way to make the diagnosis.
  • Imaging tests: Dedicated adrenal computed tomography (CT) scans or magnetic resonance imaging (MRI) may be done for detailed images of your adrenal gland and to aid in assessing the tumour’s characteristics.
  • Metaiodobenzylguanidine (MIBG) scan: MIBG scan is a nuclear imaging scan that helps reveal tumours of the adrenal medulla that may not be visible in X-ray scans.
  • Adrenal vein sampling (AVS): in rare cases, hormone-producing tumours may not be visible on scans. AVS uses blood from both adrenal glands to identify where there is an overproduction of hormones.
  • DOTATATE PET or PET-CT scan: this method combines a radioactive tracer with CT scans and locates radioactivity in your body is rarely done in adrenal malignancies to detect distant metastases.

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

Generally, if the adrenal gland tumour is small and benign, no treatment is required. However, regular follow-up and monitoring are recommended to check for any changes that may happen.

Treatment options for adrenal gland tumours can be one or a combination of the following:

  • 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 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.

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

Are adrenal gland tumours common?

Generally, adrenal gland tumours are rare, and most of them are benign (non-cancerous), but they can occur in anyone.

Do functioning adrenal tumours need to be removed?

It is recommended to remove functioning tumours, especially if they are causing hormonal imbalances or other health issues.

Can adrenal gland tumours come back after I have undergone treatment?

Adrenal gland tumours can potentially recur after treatment. You must go for regular health check-ups to monitor, detect, and address any recurrence or new developments immediately and effectively

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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.