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Adrenal Tumor: Symptoms and Differential Diagnosis

An incidentally discovered adrenal tumor is also called incidentaloma. 80% of incidentalomas have no hormone production and are without clinical significance. In 20%, treatment is necessary because of hormonal activity or tumor growth.

Signs and Symptoms of Adrenal Tumors

Most of the adrenal tumors do not cause any symptoms. Symptoms depending on hormone production are Cushing syndrome, virilization, feminization, Conn syndrome. Rarely, adrenal tumor cause abdominal pain due to local growth and infiltration.

Differential Diagnosis of Adrenal Tumor

• Adrenal adenoma: with or without hormone activity
• Pheochromocytoma
• Adrenocortical carcinoma
• Rare benign tumors: hematoma, inflammatory tumors, ganglioneuroma, lipoma, fibroma, adrenal cyst, oncocytoma
• Neuroblastoma (in children)
• Retroperitoneal lymphoma
• Metastases: breast cancer, lung cancer, renal cell carcinoma, malignant melanoma, lymphoma, ...
• Tumors with origin from neighboring organs such as kidney tumor, pancreas, spleen, bile ducts, blood vessels, lymph nodes.

Diagnostic Workup of an Adrenal Tumor

Determination of Hormone Activity

Hormone activity of the adrenal tumor is assessed with blood tests and hormone assays from 24-hour urine collection:

• Serum blood tests: sodium, potassium, aldosterone, ACTH, cortisol
• Dexamethasone suppression test: administration of 2 mg dexamethasone p.o. (11 o'clock p.m). The next day, the morning cortisol should be below 50 nmol/l (2 mg/dl).
• 24-hour urine collection: sodium, potassium, cortisol, aldosterone, vanillin mandelic acid and metanephrines
• Other tests are necessary depending on clinical suspicion or the results of the above mentioned screening tests.

Imaging of an Adrenal Tumor

Abdominal CT:

Adrenal masses larger than 5 cm are suspicious for a malignant tumor. CT characteristics for an adrenal adenoma is a native density of less than 10 HU, which increases after administration of contrast medium. 15 min after contrast medium administration, the enhancement wash-out of contrast medium should be at least 60% [Joudi et al., 2006].

MRI Abdomen:

A high signal intensity on T2-weighted images is suspicious for a malignancy.

References

  Deutsche Version: Differentialdiagnose Nebennierentumor