Adrenal Tumors

Clinical evaluation

• Evaluation begins with a thorough history of symptoms and a focused physical examination. The clinician specifically assesses for signs of hormonal excess (Cushing's features, hypertension, hypokalemia) and mass effect. A detailed family history is obtained to screen for hereditary syndromes.
  
  

Biochemical (hormonal) testing

• Hormonal evaluation is performed for all adrenal masses, regardless of clinical symptoms, to identify functional tumors that may require treatment:
  • Cortisol excess
  • Aldosterone excess
  • Catecholamine excess
  • Androgen / estrogen excess

Imaging

• CT (computed tomography)
• MRI
• PET-CT 

Biopsy

• Adrenal biopsy is not routinely performed, as it carries the risk of seeding malignant cells along the needle tract and cannot reliably distinguish benign from malignant primary adrenal tumors. It is reserved for cases where metastatic disease is suspected and will change management, and only after pheochromocytoma has been biochemically excluded.

The treatment approach is determined by the tumor type, functional status, size, imaging characteristics, and whether malignancy is confirmed or suspected.

Surgery (adrenalectomy)

• Surgical removal of the affected adrenal gland is the definitive treatment for most functional adrenal tumors and for adrenal masses with features suspicious for malignancy. The procedure is called adrenalectomy. Minimally invasive approaches are preferred for most benign and small-to-moderate-sized tumors, offering reduced operative blood loss, shorter hospital stay, and faster recovery compared with open surgery. Open adrenalectomy is reserved for large tumors, those with imaging features of local invasion, and cases of confirmed ACC where oncological principles of wide margin resection take priority.

Radiation therapy

• Radiation therapy has a limited role in adrenal tumor management. It may be used for palliation of symptomatic metastases from ACC or for treatment of inoperable or recurrent disease.

Active surveillance

• Non-functioning adrenal adenomas that are small, have reassuring imaging characteristics, and have been confirmed to be hormonally inactive may be managed with periodic surveillance — typically repeat CT or MRI at 6–12 months and annual hormonal re-testing for several years.