Adrenal Cancer

Adrenal cancer is a rare malignancy that develops in the adrenal glands, which are small hormone-producing organs located above each kidney. These glands produce hormones that regulate metabolism, blood pressure, stress response, and other bodily functions. Adrenal cancer can disrupt normal hormone production, potentially causing hormonal imbalances throughout the body, and may spread to other organs if not detected early.

Dr Ben Ng

Senior Consultant Endocrinologist

Dr Donovan Tay

Senior Consultant Endocrinologist

Symptoms of Adrenal Cancer

Patients with adrenal cancer may experience various symptoms depending on whether the tumour produces excess hormones and which specific hormones are affected.

Abdominal or Flank Pain

Pain in the abdomen or back may develop as the tumour grows and presses against nearby organs or tissues. The discomfort may range from mild to severe depending on the size and exact location of the tumour.
Unexpected Weight Loss

Loss of weight without intentional dieting may occur as cancer cells consume energy and alter metabolism. This symptom typically becomes more pronounced as the disease progresses.
Feeling of Fullness

Patients may experience a sensation of fullness or a palpable mass in the abdomen. This occurs when the tumour grows large enough to create pressure on surrounding structures.
Hormone-Related Symptoms

Excess cortisol can cause weight gain centred around the face and trunk, purple stretch marks, and muscle weakness. Aldosterone overproduction leads to high blood pressure and low potassium levels, while excess androgens may cause a deepening voice, facial hair growth, and menstrual irregularities in women.
Fever

Some patients develop unexplained fever, particularly as the disease advances. The fever may come and go or remain persistent.
Weakness and Fatigue

General weakness and persistent fatigue that does not improve with rest may indicate adrenal cancer. These symptoms often result from hormonal imbalances affecting normal energy regulation.

Causes and Risk Factors

Several factors have been associated with an increased risk of developing this condition. Common factors include:

Genetic Syndromes

Certain inherited disorders increase the risk of adrenal cancer. Li-Fraumeni syndrome, Multiple Endocrine Neoplasia type 1 (MEN1), and Lynch syndrome all involve genetic mutations that predispose individuals to adrenal and other cancers.
Family History

A family history of adrenal cancer or related endocrine tumours may indicate a higher risk. First-degree relatives of patients with adrenal cancer have an elevated risk compared to the general population.
Age

Adrenal cancer shows a bimodal age distribution. The condition appears more frequently in children under age 5 and adults between 40 and 60 years old, with fewer cases observed in other age groups.
Previous Radiation Exposure

Exposure to ionising radiation may increase the risk of adrenal cancer. This exposure typically comes from previous cancer treatments or occupational sources.

Diagnostic Methods

Blood and Urine Hormone Tests

Laboratory tests measure hormone levels to determine if an adrenal mass is producing excess hormones and which specific hormones are affected. These tests examine levels of cortisol, aldosterone, androgens, and catecholamines in blood or urine samples. The pattern of hormone abnormalities helps distinguish adrenal cancer from benign conditions and guides further diagnostic evaluation.

Computed Tomography (CT) Scan

CT imaging provides detailed cross-sectional views of the adrenal glands and surrounding structures. This technique helps determine the size and location of adrenal masses and whether they appear to invade nearby organs or blood vessels. Contrast enhancement patterns on CT can help differentiate malignant from benign adrenal tumours, with malignant lesions typically appearing larger, irregularly shaped, and heterogeneous with areas of necrosis.

Magnetic Resonance Imaging (MRI)

MRI offers detailed soft-tissue contrast that complements CT findings. This technique is particularly useful for evaluating adrenal tumours in those who cannot receive CT contrast. Certain MRI sequences, such as chemical shift imaging, can detect microscopic fat within adrenal masses, which suggests a benign adenoma rather than cancer.

Positron Emission Tomography (PET) Scan

PET imaging, often combined with CT (PET-CT), assesses the metabolic activity of adrenal masses. Cancer cells typically show increased glucose metabolism compared to normal tissues. This technique helps identify whether an adrenal mass is metabolically active (suggesting malignancy) and can detect metastases throughout the body that may be missed by other imaging methods.

Treatment Options

If adrenal cancer treatment leads to reduced hormone production, whether due to medication, surgery, or other interventions, hormone replacement therapy may be necessary to maintain essential bodily functions.

Hormonal Support After Treatment

Corticosteroid replacement: If the adrenal glands are no longer producing enough cortisol, replacement therapy such as hydrocortisone or prednisone is prescribed. These medications help regulate metabolism, immune response, and stress management. The dosage is carefully tailored to avoid under-replacement (which can lead to fatigue, low blood pressure, and weakness) or over-replacement (which can cause weight gain, high blood sugar, and osteoporosis).
Mineralocorticoid replacement: If aldosterone production is affected, fludrocortisone may be prescribed to help maintain proper blood pressure and electrolyte balance. Without sufficient aldosterone, the body can lose excessive sodium and retain too much potassium, leading to dehydration, dizziness, and low blood pressure. Patients on mineralocorticoid replacement require regular blood tests to monitor sodium and potassium levels.

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Prevention and Management

Following treatment, patients require regular hormonal evaluations to detect recurrence and monitor treatment effects. Hormone replacement therapy after adrenal surgery needs careful adjustment to prevent adrenal crisis and maintain electrolyte balance. This includes monitoring cortisol and aldosterone levels with periodic blood tests, adjusting medication dosages as needed, and educating patients about stress dosing protocols. Long-term management also involves screening for and treating hormone-related complications like osteoporosis, diabetes, and cardiovascular issues that may develop during recovery.

Frequently Asked Questions

What is the difference between a benign adrenal tumour (adenoma) and adrenal cancer?

Most adrenal tumours are benign adenomas. These typically do not spread, grow slowly, and often do not require treatment. Adrenal cancers are typically larger (>4cm), have irregular borders on imaging, may show evidence of local invasion, and have characteristic enhancement patterns on CT scans.

What is the typical follow-up schedule after treatment for adrenal cancer?

Initial follow-up typically occurs every 3 months for the first 2 years with physical examination, hormone tests, and imaging. This extends to every 6 months for years 3-5, then annually thereafter if no recurrence is detected.

Can adrenal cancer recur after successful treatment?

Yes, adrenal cancer has a recurrence rate of approximately 60-80% within 2-5 years, even after complete surgical removal. This necessitates long-term surveillance with regular imaging and hormone tests.

Dr Ben Ng

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr Ben Ng provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, obesity, and a range of other metabolic and endocrine conditions.

Adj Asst Professor Dr Ben Ng Jen Min graduated from the Queens University of Belfast Northern Ireland, United Kingdom (UK).
He completed his postgraduate training with the certificate of completion of training (CCT) from the Royal College of Physicians (UK) with dual accreditation in diabetes and endocrinology and in general internal medicine.
In 2010, he was awarded an MD with honours by the University of Hull, UK, in recognition for his research in diabetes mellitus

Dr Donovan Tay

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr. Donovan Tay provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, osteoporosis, and a range of other metabolic and endocrine conditions.

Dr. Donovan Tay graduated from the National University of Singapore (NUS) and obtained his membership in the Royal College of Physicians (UK), Master of Medicine (NUS), and Master of Clinical Investigation (NUS).
After completing training in endocrinology, he was conferred as a Fellow of the Academy of Medicine, Singapore (FAMS).
He further specialised in endocrinology with a fellowship at the prestigious Columbia University Medical Centre in New York City.

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