What Is An Adrenal Mass Types Tests Treatment?

Finding out you have an adrenal mass can be unsettling, especially because most people never knew they had adrenal glands until a scan mentioned them. An adrenal mass is a growth in one of the two small glands that sit on top of your kidneys. Most turn out to be benign and harmless, but a minority are hormone-producing tumors or, less often, cancer. Your doctor’s job is to answer two questions: is it making hormones, and is it cancer?

What Is An Adrenal Mass?

The adrenal glands are two small, triangular glands. One sits on top of each kidney. Despite their size, they produce hormones that control blood pressure, salt balance, blood sugar, the stress response, and other jobs your body depends on every minute.

An adrenal mass is any abnormal growth in that gland. It can be a solid lump, a fluid-filled cyst, or a clump of fat and tissue. The medical term for a mass found on a scan in someone with no related symptoms is an adrenal incidentaloma. That word means “found by accident,” which is exactly how most are discovered.

These masses are common. Imaging studies of the abdomen turn up an adrenal mass in a meaningful share of adults, and the odds rise with age. The large majority are benign and cause no symptoms and no harm.

What Are the Types of Adrenal Masses?

Doctors sort adrenal masses into two broad groups: those that make hormones and those that do not. Within each group are several specific types.

Hormone-producing (functioning) masses

• Aldosteronoma. Produces aldosterone, which drives up blood pressure and can lower potassium. It is a recognized cause of secondary high blood pressure.
• Cortisol-producing adenoma. Makes excess cortisol. This can cause weight gain around the middle, easy bruising, high blood sugar, and other features of Cushing syndrome.
• Pheochromocytoma. Produces adrenaline-like hormones. It can cause episodes of pounding heartbeat, sweating, headache, and very high blood pressure. This type is uncommon but important because it is dangerous if missed.

Non-functioning masses

• Adrenal adenoma. A benign, non-cancerous tumor. Most non-functioning masses are this type.
• Adrenal cyst. A fluid-filled sac, usually harmless.
• Myelolipoma. A benign mix of fat and blood-forming tissue.
• Adrenocortical carcinoma. A rare cancer of the adrenal cortex. It is uncommon, but it is the reason every adrenal mass gets taken seriously.
• Metastasis. Cancer that started elsewhere, such as the lung, and spread to the adrenal gland.

One point worth knowing: the size of a mass does not tell you whether it makes hormones. A small mass can pour out hormones, and a large one can be silent. Hormone testing and imaging answer different questions, and both are needed.

What Are the Symptoms of an Adrenal Mass?

Most adrenal masses cause no symptoms at all. They are silent, and that is precisely why they get found by accident on a scan done for some unrelated reason.

When symptoms do appear, they come from the hormones the mass releases, not from the mass itself. The pattern depends on which hormone is involved.

• High blood pressure that is hard to control, sometimes with low potassium, points toward excess aldosterone.
• Weight gain in the trunk, a rounded face, easy bruising, and high blood sugar suggest excess cortisol.
• Sudden spells of a racing heart, heavy sweating, headache, and a sense of doom suggest a pheochromocytoma.

A large mass, whether or not it makes hormones, can cause a dull ache in the belly or back as it presses on nearby structures. That is a mass effect, not a hormone effect. If you have any of these symptoms, they are worth mentioning to a doctor, but none of them confirm an adrenal mass on their own.

How Are Adrenal Masses Tested?

Testing has two separate goals, and it helps to keep them apart. One set of tests asks whether the mass makes hormones. The other asks whether it looks like cancer. A mass can pass one test and fail the other.

Hormone testing

Blood and urine tests check for excess hormone production. These typically look at cortisol, aldosterone, and the hormones that pheochromocytomas release. The exact panel is chosen by your doctor based on your symptoms and the appearance of the mass. Results are often interpreted alongside your blood pressure, potassium level, and blood sugar.

Imaging

A CT scan is the usual first imaging test. It shows the size, shape, and density of the mass. Certain features on CT, such as how much fat the mass contains and how it takes up contrast dye, help separate benign from suspicious growths. An MRI can add detail when the CT result is unclear. Some masses are also imaged with a nuclear medicine scan.

Size matters for the cancer question because larger masses are more likely to be malignant, but size alone never proves it. A small mass can still be a cancer, and a large one can still be benign.

Biopsy

A biopsy, where a needle takes a tissue sample, is used in selected cases. It is not routine, because it carries a small risk and because some masses, such as pheochromocytomas, can be risky to sample without preparation. Whether a biopsy is appropriate is a decision your doctor makes based on the whole picture.

How Are Adrenal Masses Treated?

Treatment depends entirely on two things: whether the mass makes hormones and whether it looks like cancer. There is no single answer, because the types behave very differently.

• Small, non-functioning, benign-looking masses. These are often simply watched with repeat imaging over time to confirm they are not growing. Many never need treatment.
• Hormone-producing masses. These are usually removed with surgery, because the hormones they release cause real problems. Some cases can be managed with medication, depending on the type and the person.
• Masses that look like cancer. Surgery to remove the gland is the main treatment. Adrenocortical carcinoma is rare but serious, and outcomes depend heavily on how early it is found and removed.
• Pheochromocytoma. This type needs medication to control blood pressure and heart rate before any surgery, because operating without that preparation can trigger a dangerous spike in blood pressure.

Surgery to remove an adrenal gland is called an adrenalectomy. When the mass is small and benign-looking, it is often done with a few small incisions and a camera, which is less invasive than open surgery. Larger or more suspicious masses may need a larger operation.

The decision to watch or to operate is not always clear-cut. If your mass is borderline in size or appearance, it is reasonable to ask your doctor how they weighed the risks of surgery against the risks of waiting.

What Happens After an Adrenal Mass Is Found?

The path forward usually follows a predictable sequence. Your doctor confirms the mass is real, tests whether it makes hormones, assesses how it looks on imaging, and then decides whether to watch it or treat it.

If the plan is to watch, you will likely have repeat scans at intervals to check for growth. The schedule is set by your doctor and depends on the size and appearance of the mass. A mass that stays the same size over time is reassuring. A mass that grows needs a fresh look.

If the plan is surgery, you will usually have hormone levels rechecked afterward to confirm they have returned to normal. Most people recover well, though as with any surgery there are risks that your surgeon will discuss with you.

One honest note: the evidence on exactly how often to repeat scans and for how long is not fully settled. Guidelines offer general direction, but the timing is often tailored to the individual. That is normal in this area of medicine, and it is worth asking your doctor how they arrived at your specific plan.

When Should You See a Doctor?

See a doctor if you have unexplained high blood pressure that is hard to control, especially with low potassium, or spells of a racing heart, sweating, and headache. These can have many causes, and an adrenal mass is only one of them.

If you already know you have an adrenal mass, keep your follow-up appointments. The main reason to track these masses is to catch growth or new hormone production early, when treatment tends to be simpler. Skipping scans removes that safety net.