Benign Adrenal Masses
Benign adrenal masses are non-cancerous growths of the adrenal gland. There are two adrenal glands, each one located on top of each kidney. Adrenal glands make hormones including adrenaline (epinephrine, norepinephrine), steroids (cortisol), aldosterone, as well as others.
Benign tumors that arise from the adrenal gland can be either non-functioning or hyperfunctioning (whereby normal hormones of the adrenal gland are produced in excess). In some cases, these masses produce no complications, while other masses may cause life-threatening symptoms due to the excess production of certain hormones.
In many cases, the symptoms associated with benign adrenal masses are those caused by hormonal changes in the body. In other cases, symptoms arise when the mass has grown large enough to press against other organs. These symptoms include abdominal pain, a feeling of fullness in the belly, or trouble eating because the stomach feels full quickly.
Below, the symptoms are grouped according to the hormones that would cause them.
Symptoms caused by the hormones androgen or estrogen
These tumors tend to produce the male hormones, known as androgens. The symptoms are most apparent in children and women:
- Enlargement of the penis (boys)
- Excess growth of facial, pubic, and underarm hair in children
- Excess facial hair or scalp hair loss in women
- Enlargement of the clitoris (girls)
- Irregular periods
- Deepening of the voice in women
- If the tumor creates more female hormones, known as estrogens, the following symptoms may be present:
- Early puberty in girls (having periods and the breasts getting larger)
- Breast enlargement in males (including boys)
- Decreases sex drive in men, or trouble getting an erection
- Women generally have no symptoms unless the tumor is large enough to press on nearby organs.
Symptoms caused by high levels of cortisol
When cortisol is in excess, the group of accompanying symptoms is referred to as Cushing’s syndrome. Some of these symptoms include:
- Fat deposits behind the neck and shoulders
- Weight gain, often around the chest and stomach
- Purple stretch marks on the stomach
- Hair growth on the face, chest, and back in women
- Irregular periods
- Weakness in the legs
- Easy bruising
- Depression or moodiness
- Weak bones, which can lead to broken bones
- High blood sugar, often leading to diabetes
- High blood pressure
Symptoms caused by high aldosterone levels
Excess aldosterone often causes the following:
- High blood pressure
- Muscle cramps
- Increased thirst
- Urinating very often
It is important to understand that having one or more of the symptoms below does not mean that you have an adrenal mass. Many of these symptoms can be caused by benign conditions that affect the endocrine system. If you think you may have an adrenal mass, please call your doctor.
Surgical removal of an adrenal gland, or adrenalectomy, is most commonly performed for a tumor located within the adrenal gland that is overproducing hormones. If both adrenal glands need to be removed, then patients will need to take medications to replace the hormones that would normally be excreted by the adrenal glands. If the masses are producing no symptoms, then a wait-and-see approach is often taken.
In a traditional adrenalectomy, an incision is made over the abdomen or side in order to provide direct access to the adrenal gland. A laparoscopic adrenalectomy requires smaller incisions. During a laparoscopic procedure, three to four half-inch incisions are made, and surgeons use a camera for visual guidance and special instruments to remove the adrenal gland or glands. With a laparoscopic adrenalectomy, most patients go home within 24 to 72 hours and experience less postoperative discomfort and a shorter recovery time than patients who have a traditional adrenalectomy. The majority of our adrenalectomies are performed using laparoscopic methods.
Some patients may not be able to have their tumors treated surgically because of the way it is growing or if it is cancerous and has spread to other parts of the body. In these cases, the patient should work with their endocrinologist to determine the best course of treatment.