Unilateral tumors or masses of the adrenal gland are common. They are categorized as either functional (hormone-secreting) or nonfunctional, and as either benign or malignant.
- The majority of adrenocortical tumors are benign, nonfunctioning adenomas that are discovered incidentally on abdominal imaging studies (adrenal incidentalomas).
- Others are benign, hormone-secreting adenomas that cause Cushing's syndrome, primary aldosteronism, or much less commonly, virilization.
- Adrenocortical carcinomas (ACCs) are rare, frequently very aggressive tumors that may be functional, and cause Cushing's syndrome and/or virilization, or nonfunctional, and present as an abdominal mass or as an incidental finding.
- Pheochromocytomas are catecholamine-secreting tumors (benign or malignant) that arise from chromaffin cells of the adrenal medulla. These are discussed separately. (See "Treatment of pheochromocytoma in adults".)
The treatment of adrenocortical adenomas will be reviewed here. The treatment of adrenocortical carcinoma and the clinical presentation and evaluation of all adrenocortical tumors are discussed separately. The rarer micronodular and macronodular adrenal disorders that cause Cushing's syndrome are also reviewed separately. (See "Clinical presentation and evaluation of adrenocortical tumors" and "Treatment of adrenocortical carcinoma" and "Cushing's syndrome due to ACTH-independent macronodular adrenal hyperplasia" and "Cushing's syndrome due to primary pigmented nodular adrenocortical disease".)
TYPES OF ADRENOCORTICAL ADENOMAS
Adrenocortical adenomas are benign neoplasms of adrenocortical cells. Although most are nonfunctional, some secrete steroids independently from ACTH or the renin-angiotensin system. Many are discovered incidentally on abdominal imaging studies (adrenal incidentalomas), while others present with symptoms of hormonal excess.
After the initial discovery of an adrenal mass, subsequent evaluation should determine whether it is benign or malignant, and whether it is functional or nonfunctional, in order to determine treatment options. (See "Clinical presentation and evaluation of adrenocortical tumors".)