Adrenal Adenoma: Symptoms, Hormonal Effects, and Management

Understanding Adrenal Adenomas

Adrenal adenomas are benign tumors of the adrenal cortex. Most are nonfunctional (hormonally silent) and discovered incidentally ("incidentalomas"). However, some secrete excess hormones, causing distinct clinical syndromes.

1. Hormonally Functional Adenomas

• Cushing's syndrome: Cortisol excess → weight gain (central obesity), hypertension, glucose intolerance, skin thinning, easy bruising, muscle weakness.
• Primary aldosteronism (Conn's syndrome): Aldosterone excess → hypertension, hypokalemia, metabolic alkalosis.
• Pheochromocytoma (catecholamine-secreting): Typically arises from adrenal medulla, not cortex; causes paroxysmal hypertension, palpitations, sweating, headaches.

2. Size and Malignancy Risk

• <4 cm: Low malignant potential; usually monitored with imaging.
• ≥4 cm or rapid growth: Higher concern for adrenocortical carcinoma; surgical resection often recommended.

3. Evaluation and Follow-up

• Hormonal workup: 1-mg dexamethasone suppression test, plasma metanephrines, aldosterone/renin ratio.
• Imaging: CT or MRI with washout characteristics to assess lipid content (suggests benign adenoma).
• Monitoring: Repeat imaging in 6–12 months for small, nonfunctional tumors; annual biochemical screening for 5 years.

4. Treatment

• Nonfunctional, small (<4 cm), stable tumors: Surveillance.
• Functional tumors or large/suspicious masses: Laparoscopic adrenalectomy (preferred).
• Medical management (e.g., mineralocorticoid receptor antagonists for aldosteronism) if surgery contraindicated.

Consult an endocrinologist for personalized assessment and management.