Adrenal Tumors: Do They Require Monitoring or Surgery?

Adrenal adenoma

After a CT scan ordered by a surgeon, an adrenal adenoma was incidentally discovered and referred to a urologist.
The physician directly assessed it as benign but still ordered blood tests and 24-hour and 12-hour urine total volume tests.
The test results showed abnormalities, but the physician stated that there was no hypertension, so no further evaluation was conducted.
The size of the adrenal adenoma was also not mentioned.
Could you please clarify whether the adrenal adenoma is of no concern and if there is no need for follow-up or surgery?

Gui Mei, 30~39 year old female. Ask Date: 2018/11/06

Dr. Chen Sirong reply Oncology

Hello! You must be a kind spirit to have unexpectedly discovered a tumor!
1.
Regarding the size of the adrenal adenoma: A tumor smaller than 4 cm has about a 2% chance of being malignant, while a tumor larger than 6 cm has a 25% chance of being malignant.
2.
As for whether an adrenal adenoma requires monitoring or surgery: It is advisable to have regular follow-ups.
If the tumor causes any symptoms, adrenalectomy should be performed for treatment.
Indications for surgery include: adrenal cortical tumors that excessively produce hormones, adrenal medullary tumors that excessively produce catecholamines (such as pheochromocytoma), adrenal tumors larger than 4 cm, or suspected malignant tumors.
Primary malignant adrenal tumors or adrenal tumors associated with symptoms, such as back pain, also warrant surgical intervention.
Wishing you a speedy recovery.
Dr.
Chen Sih-Rong, Taoyuan Hospital.

Reply Date: 2018/11/06

More Info

Adrenal tumors, particularly adrenal adenomas, are often discovered incidentally during imaging studies for unrelated issues. The management of these tumors can vary significantly based on several factors, including the size of the tumor, the presence of hormonal activity, and the patient's overall health.
In your case, it seems that a urologist has assessed the adrenal mass and deemed it benign. This is a common initial assessment, especially if the tumor is small (typically less than 4 cm) and there are no signs of hormonal overproduction or malignancy. However, the fact that abnormal results were noted in your blood and urine tests suggests that further evaluation may be warranted.

Monitoring vs. Surgery
1. Size and Characteristics: Generally, adrenal tumors that are less than 4 cm in size and are non-functioning (not producing excess hormones) can often be monitored rather than surgically removed. If the tumor is larger than 4 cm, or if it shows signs of malignancy or hormonal activity, surgical intervention may be necessary.

2. Hormonal Activity: Adrenal tumors can be classified as functioning or non-functioning. Functioning tumors produce hormones such as cortisol, aldosterone, or catecholamines, which can lead to various health issues, including hypertension, Cushing's syndrome, or Conn's syndrome. If your tests indicate that the tumor is producing excess hormones, this would necessitate surgical removal, regardless of size.

3. Follow-Up Recommendations: If the tumor is small and non-functioning, regular follow-up imaging (such as CT scans) may be recommended to monitor for any changes in size or characteristics. The frequency of these follow-ups can vary, but typically, imaging is done every 6 to 12 months for the first few years after diagnosis.

4. Blood and Urine Tests: The abnormal results from your blood and urine tests should be carefully evaluated. These tests can help determine if the adrenal tumor is functioning. For example, a 24-hour urine free cortisol test can help diagnose Cushing's syndrome, while plasma aldosterone and renin levels can assess for primary hyperaldosteronism.

Conclusion
In summary, while your urologist may have initially deemed the adrenal tumor benign, the presence of abnormal blood and urine test results suggests that further evaluation is necessary. It is crucial to have a thorough discussion with your healthcare provider about the implications of these findings. Depending on the results of your hormonal evaluations, you may need to consider either ongoing monitoring or surgical intervention.

If you have concerns about the size of the tumor or the results of your hormonal tests, it may be beneficial to seek a second opinion from an endocrinologist, who specializes in hormonal disorders and adrenal tumors. They can provide a more comprehensive assessment and guide you on the best course of action based on the latest medical guidelines and your specific situation.

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