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Patient Resources

Adrenal Incidentaloma

January 25, 2022

An adrenal incidentaloma is an unsuspected tumor in one or both of your adrenal glands. This type of tumor is usually found by chance during an imaging test, such as an ultrasound or CT scan, for another condition.

Endocrine Connection

Adrenal tumors can be either non-functional or functional. Functional adrenal tumors make hormones in higher amounts than normal. Both cancerous and non-cancerous tumors can produce too much hormone. Tumors can sometimes make too much of more than one hormone.

These hormones include:

  • Cortisol – Cushing syndrome or subclinical hypercortisolism are conditions caused by too much cortisol
  • Aldosterone - Primary aldosteronism is a condition caused by too much aldosterone
  • Adrenaline hormones (epinephrine and norepinephrine) - Pheochromocytomas are rare adrenal tumors that produce too much adrenaline hormone
  • Androgens (testosterone and testosterone building blocks)

Your doctor will evaluate your tumor to identify its cause and hormone production. This may include: 

  • Your medical history 
  • A review of your symptoms 
  • A physical exam: a check of your blood pressure, pulse rate, body weight, and other signs 
  • Blood and/or urine tests to check hormone levels and to rule out hormone excess 
  • Results of genetic tests (rarely) 

Your doctor also will need to know your family history of adrenal tumors, other kinds of tumors, high calcium levels, kidney stones, high blood pressure, or other hormone problems. There are a number of causes of adrenal tumors including: 

  • An adenoma (a non-cancerous tumor in the adrenal glands) 
  • Cancer of the adrenal gland or spread of cancer from elsewhere in the body 
  • Cysts in or on the adrenal glands 
  • Other less common conditions, such as tumors filled with fat and blood cells 

Even when discovered incidentally, adrenal tumors may cause symptoms. Symptoms vary depending on whether the tumor is non-functional or functional, and which, if any, hormones are produced in excess.  

Symptoms of too much cortisol can include: 

  • Weight loss or weight gain (especially around the face and abdomen) 
  • Purplish skin stretch marks or skin that’s easily bruised 
  • Muscle weakness 
  • Depression, anxiety, fatigue, and sleep disturbances 
  • In women, excess facial and body hair, acne, and/or irregular menstrual periods 
  • High blood pressure 
  • High blood sugar 
  • Low bone density (when your bones start to thin and become more brittle) 

Symptoms of too much aldosterone can include: 

  • High blood pressure 
  • Low blood potassium levels 
  • Muscle weakness (rarely) 

Symptoms of too much norepinephrine or epinephrine can include: 

  • Fast or irregular heartbeat 
  • Sweating 
  • Severe headaches 
  • Shakiness 
  • Pale face 
  • High blood pressure 

Symptoms of high levels of androgens in women can include: 

  • Excess facial and body hair
  • Male-pattern baldness
  • Acne
  • Irregular menstrual periods 

About 85% of adrenal tumors are non-functioning and may not need treatment. Sometimes surgery is needed to remove the tumor, or one or both adrenal glands. Your medical team will decide whether you need surgery based on your type of tumor (benign or cancerous) and whether it is producing hormones. If you have an inherited tumor syndrome, you may need genetic counseling. If you’ve had an adrenal incidentaloma, you may need regular follow-up to repeat hormone testing and radiologic imaging.

  • Do I have a hormonally active tumor? 
  • What tests do I need? 
  • What are my options for treatment? 
  • What are the risks and benefits of each treatment option? 
  • How long will I need treatment? 
  • How often will I need check-ups? 
  • Should I see an endocrinologist?   

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