What is it?

Adrenal glands are hormone producing glands located on top of each kidney. An Adrenal incidentaloma is an asymptomatic adrenal mass (≥1 cm in diameter) that is detected on imaging performed for indications other than evaluation for adrenal disease.[1]  

What are the causes?[2]

• 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

What are the signs and symptoms?

Most of the patients with adrenal incidentaloma may not have any symptoms. These are called non-functional adenomas. In some cases, the adrenal mass produces high levels of hormones called epinephrine, cortisol or aldosterone. These tumors are called functional adenomas. 

Symptoms will depend on the type of excess hormones that the adrenal mass is producing.

• Tumors that secrete cortisol cause a condition called Cushing’s syndrome.[3] Signs and symptoms include:
  • Progressive weight gain affecting the face, neck, trunk, and abdomen more than the limbs, which may be thin.
  • Tiredness and loss of energy
  • Muscle loss and weakness manifested as difficulty in climbing stairs or arising from low chair.
  • High blood pressure
  • High blood sugar
  • Easy bruising and purple stretch marks in the skin can develop in areas of weight gain.
  • Facial hair, acne, and menstrual irregularities in women
  • Depression and insomnia

• Tumors that secrete aldosterone cause a condition called primary aldosteronism.[4] Signs and symptoms include:
  • High blood pressure that may be difficult to control (requiring more than 3 antihypertensive medications).
  • Hypertension and a family history of early onset hypertension or stroke at a young age (<40 years) .
  • Headache
  • Weakness or numbness
  • Low potassium (excessive amount of urination or muscle cramps)

• Tumors that secrete adrenaline hormones cause a condition called pheochromocytoma[5]. Signs and symptoms include:
  • Hypertension
  • Headaches
  • Rapid heartbeats (palpitations)
  • Profuse sweating
  • Anxiety and panic attacks

How is it assessed?

This condition may be evaluated based on:

• Your symptoms. Your doctor may suspect the condition if you have signs and symptoms of a functional adenoma.
• Your medical history and physical exam.
• Blood and urine tests to check for high levels of hormones.
• Rarely results of genetic tests

How is it treated?

Treatment depends on the type of the adrenal mass.

• Non-Functional Adenoma: You may not need treatment and just be under observation if you have a nonfunctional adrenal adenoma. For observation, you may need a regular imaging studies to make sure the tumor is not growing and blood or urine tests to make sure the tumor is not becoming functional.
• Functional Adenoma: Your medical team will decide if you will need surgery if you have a functional adrenal adenoma. Surgery to remove the tumor is the usual treatment for functional adenomas. You may also be prescribed medicines that block the effects of the hormones if surgery is not possible.

References:

1. Young WF Jr. The incidentally discovered adrenal mass. N Engl J Med 2007; 356:601-10.
2. Hormone Health Network. “Adrenal Incidentaloma, Hormone Health Network”. Hormone.org Endocrine Society, 30 July 2021. https:www.hormone.org/diseases-and-conditions/adrenal-incidentaloma
3. Orth DN. Cushing’s syndrome. N Engl J Med 1995; 332:791-803.
4. Funder JW, Carey RM, Mantero F et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endorine Society Clinical Practice Guideline. J Clin Endocrinol Metab, May 2016, 101(5):1889 –1916.
5. Neumann HPH, Young WF Jr, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med 2019; 381:552-565.

[1] Young WF Jr. The incidentally discovered adrenal mass. N Engl J Med 2007; 356:601-10

[2] Hormone Health Network. “Adrenal Incidentaloma, Hormone Health Network”. Hormone.org Endocrine Society, 30 July 2021. https:www.hormone.org/diseases-and-conditions/adrenal-incidentaloma

[3] N Engl J Med 1995; 332:791-803

[4] J Clin Endocrinol Metab, May 2016, 101(5):1889 –1916

[5] N Engl J Med 2019; 381:552-565