Adrenal Disease & Surgery
A tumor begins when normal cells change and grows abnormally, forming a mass. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to or from other parts of the body).
An adrenal gland tumor can sometimes overproduce hormones. When it does, the tumor is called a functioning tumor. An adrenal gland tumor that does not produce hormones is called a non-functioning tumor. The symptoms and treatment of an adrenal gland tumor depend on whether the tumor is functioning or non-functioning, and what hormone(s) is overproduced.
Adenoma is the most common type of adrenal gland tumor. It is a noncancerous tumor that usually does not cause symptoms, and, if it is small, often does not need treatment.
Cancer of the adrenal gland itself is extremely rare and occurs in about one person per million in this country. It accounts for less than 5% of adrenal tumors. Adrenocortical carcinoma can be a functioning or non-functioning tumor. If the tumor is functioning, it may produce one or more hormone. A tumor can start in an adrenal gland (called a primary adrenal tumor) or it can begin in another organ, such as the lungs, and then metastasize (spread) to the adrenal glands. General symptoms include fever, abdominal pain, weight loss and a mass that you can feel. Increased hormone levels can cause an increase in heart rate, potentially high blood pressure and blood sugar, excess hair growth, bruising, increased thirst and frequent urination.
The role of the radiologist is particularly valuable in the diagnosis and treatment of the adrenal glands. From a diagnostic perspective, state of the art CT and MRI imaging can provide detailed information about the anatomy of the adrenal glands. These examinations can show benign or malignant tumors in exquisite detail. MRI has the added benefit of providing information about chemical content in the cells of tumors that are discovered. If a biopsy is indicated, CT scans allow the Interventional Radiologist to sample a tumor with extreme precision, making the procedure both safe and accurate.
Interventional Radiologists, with their technical skills using catheters and other medical devices, can be essential members of the endocrine medical team. Using minimally invasive techniques and imaging guidance, these specialized physicians compliment the care of the endocrine patient in areas of diagnosis and treatment. For example, micro-catheters can be directed into the veins draining an adrenal gland suspected of over-producing or under-producing a particular hormone. Samples of the vein blood can be obtained and then analyzed for specific adrenal hormones.
Once the appropriate diagnosis is made, recommendations regarding observation with follow up, treatment with medication or surgical intervention will be made. The majority of patients requiring removal of their adrenal tumor are candidates for minimally invasive surgery using laparoscopy. This procedure is performed under general anesthetic and 3-4 small incisions, each measuring ¼ to ½ inch, are made for introduction of a camera and miniature instruments for removal of the abnormal gland.
Patients may often be discharged from the hospital the day following the procedure. Rarely an open technique is required for the removal of the diseased gland. Depending on the indication for adrenalectomy, it is often necessary to have certain factors such as the blood pressure monitored closely postoperatively. The full effect of the operation on alleviating symptoms is not always immediately apparent and changes in medication will need to be made with the assistance of other specialists.
Conn’s Syndrome (Primary Hyperaldosteronism)
Conn’s Syndrome, also known as primary hyperaldosteronism, is the overproduction of aldosterone by a tumor in the adrenal gland. Many of these patients have had longstanding high blood pressure which has been difficult to control along with low potassium levels on their routine blood test. In fact, primary hyperaldosteronism (PA) is the most common cause of secondary hypertension, affecting 5-13% of patients with hypertension. Their symptoms are often vague and may include headaches, fatigue, muscle weakness, thirst and frequent urination.
Hypertension is a symptom of Conn’s syndrome, although it also a major health concern affecting roughly 70 million Americans. The vast majority of patients have primary or “essential” hypertension and treatment is aimed at lifestyle changes and appropriate use of antihypertensive medications. However, 5-13% of patients have secondary hypertension, which is most commonly caused by primary hyperaldosteronism. Other symptoms of primary hyperaldosteronism can be determined through biochemical screening by a provider and include suppressed renin activity (PRA) and increased serum aldosterone concentration.
Laparoscopic adrenalectomy or, in appropriately selected patients, endoscopic posterior adrenalectomy, is associated with low morbidity and mortality and results in improved hypertension in about 90% of patients. Thirty to 60% of cases will result in cure without need for additional antihypertensives. Success is dependent on timely treatment at a younger age and early in the onset of hypertension.