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Hormonally Active Adrenal Tumors

Adrenal nodules are often discovered accidentally when patients have abdominal CT scans or MRIs for other conditions. Almost all of these nodules are benign (not cancerous), particularly if they are smaller than 1 inch (3 centimeters) in diameter. However, even small adrenal nodules can cause clinical symptoms by over-producing adrenal hormones like epinephrine, cortisol, aldosterone and testosterone.

Epinephrine-Secreting Tumors

Epinephrine is the body's main acute stress hormone. This is the hormone that causes a person's heart to race after narrowly avoiding an automobile accident. Epinephrine- or norepinephrine-secreting tumors cause high blood pressure, diabetes, headaches, sweating and dizziness. Physicians call these tumors pheochromocytomas. They are quite unusual and cause less than 1 percent of the cases of hypertension seen in an endocrinologist's office. Diagnostic screening for pheochromocytoma is complicated and requires blood specimens and 24-hour urine collections. Surgical removal should only be attempted by experienced surgeons and anesthesiologists, as pheochromocytoma patients tend to suffer severe blood pressure swings during and after surgery. Pheochromocytoma surgery can be accomplished with minimally invasive laparoscopic techniques if the tumor is solitary, less than 3 inches in diameter, and the surgeon has extensive laparoscopic experience.

Cortisol-Secreting Tumors

Cortisol is the body's chronic stress hormone. Cortisol-secreting adrenal tumors present with diabetes, abdominal weight gain, high blood pressure, osteoporosis and muscle fatigue. High cortisol levels over the long term weaken the immune system's defenses to combat serious infections. Diagnosis is made by documenting chronic abnormal cortisol levels in blood and 24-hour urine collections. If the adrenal nodule is directly responsible for cortisol excess, it can be removed laparoscopically by a specially trained minimally invasive endocrine surgeon.

Aldosterone-Secreting Tumors

Aldosterone is a hormone that causes the body to retain salt. Aldosterone-secreting adrenal tumors cause high blood pressure and low blood potassium levels. Diagnosis is made by inserting a catheter into the right and the left adrenal veins from the groin and drawing blood samples for plasma aldosterone from each gland. If the aldosterone over-production is clearly on the same side as the adrenal nodule, then surgical excision of the nodule through a laparoscope should be curative.

DHEA- and Testosterone-Secreting Tumors

Adrenal tumors can overproduce sex hormones, for example, testosterone and dehydroepiandrosterone (DHEA). DHEA is a natural steroid converted into male and female hormones. These hormones cause women to become masculinized with the growth of hair on the face, abdomen, lower back and legs. In addition, facial acne and hypertension may become a problem. Diagnosis is made by measuring blood testosterone and DHEA levels and performing adrenal catheterization to make sure that the excessive male hormone production is coming from the adrenal gland that contains the nodule. Laparoscopic adrenal removal is readily accomplished by an endocrine surgeon if the nodule is smaller than 3 inches in diameter.

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