Adrenal Adenoma: Symptoms, Diagnosis, and Treatment Options

An adrenal adenoma is a benign (non‑cancerous) tumor that arises in the adrenal cortex. The adrenal glands sit atop each kidney and produce hormones that regulate metabolism, blood pressure, immune response, and stress.

Symptoms

Most adrenal adenomas are small (under 4 cm) and non‑functioning, causing no symptoms. When they secrete excess hormones, the following may occur:

• High blood pressure (often resistant to standard therapy)
• Diabetes or impaired glucose tolerance
• Weight gain, especially central obesity
• Muscle weakness
• Thinning skin, easy bruising, purple striae (Cushing’s syndrome)
• Excessive body hair (hirsutism) in women
• Menstrual irregularities or infertility

Diagnosis

• Hormonal workup: Blood and urine tests for cortisol, aldosterone, androgens, and metanephrines.
• Imaging: CT or MRI of the abdomen characterizes size, density, and laterality.
• Adrenal venous sampling: Occasionally used to lateralize hormone excess.

Treatment

• Observation: Small (<4 cm), non‑functioning adenomas with benign imaging features can be monitored with periodic imaging and hormonal reassessment.
• Surgical resection (adrenalectomy): Indicated for tumors >4 cm, suspicious imaging features, or hormone‑secreting adenomas (e.g., Conn’s syndrome, Cushing’s, pheochromocytoma). Laparoscopic adrenalectomy is the standard approach.

Prognosis & Follow‑up

Surgery is curative for functioning adenomas. Recurrence is rare but possible; long‑term surveillance may include annual biochemical testing. Patients with bilateral disease or genetic syndromes (e.g., MEN1, Carney complex) require multidisciplinary care.