Adrenal Tumor

Adrenal Tumor – Treatment Options

Introduction
Adrenal tumors are neoplasms that arise from the adrenal cortex or medulla. They can be benign (adenomas) or malignant (adrenocortical carcinoma, metastatic lesions), and they may be functional (hormone-secreting) or non-functional (incidentalomas). Functional tumors present with endocrine syndromes such as Cushing’s syndrome (cortisol excess), Conn’s syndrome (aldosterone excess), or pheochromocytoma (catecholamine excess). Non-functional tumors are often discovered incidentally on imaging. Treatment depends on the type, size, functional status, and malignancy potential of the tumor.

---

1. Adrenal Adenoma (Benign, Non-Functional)

• Observation:

  • Small, non-functional tumors (<4 cm) with benign imaging features can be monitored.

  • Regular follow-up with CT/MRI and endocrine testing every 6–12 months.

• Surgical removal:

  • Indicated if the mass grows, shows suspicious imaging features, or becomes functional.

---

2. Functional Adrenal Adenomas

• Cortisol-secreting (Cushing’s syndrome):

  • Adrenalectomy is the definitive treatment.

  • Preoperative medical therapy with cortisol synthesis inhibitors (ketoconazole, metyrapone, mitotane) may be used if surgery is delayed.

• Aldosterone-secreting (Conn’s syndrome):

  • Unilateral adenoma: Laparoscopic adrenalectomy.

  • Bilateral hyperplasia: Medical therapy with spironolactone (25–400 mg/day) or eplerenone (25–100 mg/day).

• Androgen- or estrogen-secreting tumors:

  • Adrenalectomy is indicated due to risk of malignancy and hormonal imbalance.

---

3. Pheochromocytoma (Catecholamine-Secreting Tumor)

• Preoperative preparation:

  • Alpha-blockade (phenoxybenzamine, doxazosin) for 7–14 days to control hypertension.

  • Beta-blockers added after alpha-blockade if tachycardia persists.

• Definitive treatment:

  • Surgical removal (adrenalectomy), preferably laparoscopic in benign cases.

• Postoperative monitoring:

  • Watch for hypotension, hypoglycemia, and recurrence.

---

4. Adrenocortical Carcinoma (ACC)

• Surgical resection:

  • Radical adrenalectomy with en bloc removal of involved tissues.

• Adjuvant therapy:

  • Mitotane is the drug of choice for residual or metastatic disease.

  • May be combined with chemotherapy (etoposide, doxorubicin, cisplatin).

• Radiotherapy:

  • Sometimes used for palliation or local control.

---

5. Metastatic Adrenal Tumors

• Systemic therapy:

  • Treatment is directed at the primary cancer (lung, breast, kidney, melanoma).

• Surgical removal:

  • Considered in solitary metastasis for select patients.

• Palliative management:

  • Hormonal replacement if adrenal insufficiency develops.

---

6. Supportive and Long-Term Care

• Hormone replacement:

  • Patients who undergo bilateral adrenalectomy or develop adrenal insufficiency require lifelong hydrocortisone (15–25 mg/day) and fludrocortisone (0.05–0.2 mg/day).

• Surveillance:

  • Regular imaging and hormonal evaluation to monitor recurrence or progression.

• Patient education:

• Stress dosing of steroids, medical alert identification, and emergency hydrocortisone kits for those with adrenal insufficiency.