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What is an Adrenal Mass?

By J.M. Willhite
Updated Mar 03, 2024
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An adrenal mass is an abnormal growth that develops in the adrenal gland. Also known as pheochromocytomas, they are usually benign and frequently diagnosed in individuals of middle age. Treatment is dependent on several factors, including the size and location of the tumor, whether it has metastasized, and the overall health of the individual.

A pheochromocytoma is a rare condition that involves the formation of an abnormal mass within the adrenal gland. Located just above the kidneys, the adrenal glands work to produce hormones — a process that becomes disrupted in the presence of a tumor. The adrenal glands of an individual with a mass produce too many hormones, including norepinephrine and epinephrine, leading to the development of an increased heart rate and high blood pressure. Though the condition may develop in anyone of any age, these masses are common in individuals 40 years of age and older.

There is no known, definitive cause for the development of a pheochromocytoma. It has been asserted that the condition may originate with the abnormal development of chromaffin cells, which are found in the center of the adrenal gland. Commonly inducing episodes of high blood pressure, known as hypertensive crises, symptoms may be triggered by a variety of environmental and physiological factors that affect hormone production and release. The use of certain drugs, including monoamine oxidase inhibitors (MAOIs), amphetamines, and decongestants, often elevates blood pressure and may induce a hypertensive crisis. Physical strain associated with heavy lifting, pregnancy, and exercise may place pressure on the tumor, triggering an episode of elevated blood pressure.

Individuals with adrenal masses may experience a variety of symptoms stemming from excessive hormone production, although elevated blood pressure and increased heart rate are the most common. Those who become symptomatic may also develop signs that include abdominal discomfort, excessive sweating, and paleness. Additional warning signs include unintended weight loss, feelings of uneasiness and anxiety, and frequent headaches of varying intensity and duration.

Tests used to determine the presence of a suspected mass may include imaging testing, urinalysis, and blood tests. Magnetic resonance imaging (MRI) and computerized tomography (CT) scans are used to detect the existence and precise location of an adrenal mass. In some cases, the existence of an asymptomatic adrenal tumor may be discovered during testing for an unrelated condition. Masses discovered incidentally may prompt further testing to analyze hormone levels in the urine and blood. Incidental adrenal gland masses may simply require periodic monitoring and no treatment.

Upon the discovery of a tumor, the individual may be treated with a combination of medications and surgery. In most instances, the mass must be surgically removed to prevent complications. Prescription medications, such as beta- and alpha-blockers, may be recommended to lower blood pressure and regulate heart rate. Once the individual is stabilized through the use of prescription medications, he or she may be scheduled for surgery to remove the pheochromocytoma.

The surgical procedure involves the complete removal of the tumor and affected adrenal gland. In instances where both adrenal glands are affected by the mass' presence, both glands may be removed, requiring the administration of hormone replacement therapy. The removal of the tumor and affected gland may be performed through either an open surgery or laparoscopically. The surgical approach utilized is dependent on the location and size of the mass. For some individuals, surgically removing the mass may not be an option.

If the adrenal mass has been determined to be malignant, treatment may extend beyond surgery and a prescription medication regimen. When the cancer has spread to other parts of the body or has grown aggressively, affecting surrounding tissues, treatment may involve the administration of chemotherapy and radiation. Treatment options for individuals with a malignant tumor that has metastasized are dependent on the aggressiveness, extent and location of the tumor, and the overall health of the individual.

The presence of a benign pheochromocytoma may increase an individual’s risk of damage to his or her internal organs. When high blood pressure is left untreated, the functionality of all the body's major organs becomes jeopardized. Individuals with untreated high blood pressure are at an increased risk for developing complications that include seizures, organ failure, and psychosis. Excessive exposure to high hormone levels, as associated with a pheochromocytoma, may contribute to the development of diabetes and congestive heart failure.

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Discussion Comments
By anon312222 — On Jan 06, 2013

@anon255331: I can help with your question. Most pheos have both types of cells within the tumor. So when a pathologist looks at the tumor and sees the malignant sort, they have to report it. The problem with that is most of the pheo tumors turn out to be benign and don't come back, so the only way to know is a lifetime follow up to see if it comes back and/or spreads.

Leading experts on pheo say that even the benign looking tumors require yearly follow ups just to make sure none come back. So pathology alone cannot tell if a pheo is benign or malignant. The doctor has to weigh many factors before coming to that conclusion. Some of those factors are: Age of the patient, family history, location of the tumor, size of the tumor, pathology of the tumor, and genetic testing results (I believe there are now 11 genetic mutations that cause pheos to form.) The only way to know with 100 percent certainty, though, is if it comes back and/or spreads.

There's an organization called the Pheo Para Troopers, it's a patient-run advocacy group. You can find them if you look up that name. They have a quarterly newsletter that talks about everything pheo and answers many questions that people may have about pheochromocytoma and paraganglioma.

I'm not a doctor, but I have spent most of my life learning about and advocating for pheo and paras.

By anon255331 — On Mar 16, 2012

My husband was diagnosed with a pheochromocytoma on the left adrenal gland. He had open surgery and it was removed two weeks ago. He went for a check-up this week and the doctor said that the tumor came back malignant, but that just because there are cancerous cells in the blood vessels doesn't necessarily mean it is cancer? None of the tests have shown that it has metastasized anywhere but that he was unable to locate all of his lymph nodes in his abdomen during surgery. We are left very confused and have no idea what to think. Does anyone understand this who can help us out?

By anon180244 — On May 26, 2011

I'm 34, and a usc and ct scan contrast have revealed a 24mm adrenal adenoma. What will be done further? Please reply. It is urgent. An aurine vma is being done and I am awaiting results. Please help.

By GuyOnBike — On May 11, 2011

Hi -- I am kind of worried after reading this because my brother has been feeling under the weather for a few weeks lately, just losing weight and not sleeping, and so after reading this I'm afraid that he might have an adrenal mass.

He is really pale naturally, but he seems even paler recently, and just exhausted all the time, but we can't figure out what's wrong with him. He hasn't been sick lately or anything, and before this he was in fairly good health generally.

Do you think he might be at risk for an adrenal mass? Or can anybody who has an adrenal mass tell me more about how to spot it so that I can try to see if my brother has one?

By BadJohnson — On May 08, 2011

Taking vitamins can help prevent a lot of diseases. I'm sure I've seen adrenal support supplements at the Healthfood store. Does anybody know if something like that could prevent an adrenal mass from forming?

By flowerchild — On Mar 04, 2011

My sister has what is commonly known as adrenal fatigue. According to her doctor it is the new epidemic of women thirty-five and older.

We have totally burned ourselves out by trying to have it all and be all to everyone. I am amazed at all the adrenal symptoms you can get!

According to the research her doctor gave us to read, hormones, sleep patterns and your energy level, are all affected by the adrenal glands.

Unfortunately, her doctor told her to cut back on the coffee and sugar, and to change her diet to one with more fruit, veggies, organic meats and no processed foods.

I am supporting her by making the same lifestyle changes in my diet. Her doctor has also recommended she eat kelp, which she can buy at the local organic grocery store. This will help to support the adrenal glands and the thyroid, which apparently work together.

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