An adrenal mass is an abnormal growth that develops in the adrenal gland. Also known as pheochromocytomas, they are usually benign and frequently diagnosed in individuals of middle age. Treatment is dependent on several factors, including the size and location of the tumor, whether it has metastasized, and the overall health of the individual.
A pheochromocytoma is a rare condition that involves the formation of an abnormal mass within the adrenal gland. Located just above the kidneys, the adrenal glands work to produce hormones — a process that becomes disrupted in the presence of a tumor. The adrenal glands of an individual with a mass produce too many hormones, including norepinephrine and epinephrine, leading to the development of an increased heart rate and high blood pressure. Though the condition may develop in anyone of any age, these masses are common in individuals 40 years of age and older.
There is no known, definitive cause for the development of a pheochromocytoma. It has been asserted that the condition may originate with the abnormal development of chromaffin cells, which are found in the center of the adrenal gland. Commonly inducing episodes of high blood pressure, known as hypertensive crises, symptoms may be triggered by a variety of environmental and physiological factors that affect hormone production and release. The use of certain drugs, including monoamine oxidase inhibitors (MAOIs), amphetamines, and decongestants, often elevates blood pressure and may induce a hypertensive crisis. Physical strain associated with heavy lifting, pregnancy, and exercise may place pressure on the tumor, triggering an episode of elevated blood pressure.
Individuals with adrenal masses may experience a variety of symptoms stemming from excessive hormone production, although elevated blood pressure and increased heart rate are the most common. Those who become symptomatic may also develop signs that include abdominal discomfort, excessive sweating, and paleness. Additional warning signs include unintended weight loss, feelings of uneasiness and anxiety, and frequent headaches of varying intensity and duration.
Tests used to determine the presence of a suspected mass may include imaging testing, urinalysis, and blood tests. Magnetic resonance imaging (MRI) and computerized tomography (CT) scans are used to detect the existence and precise location of an adrenal mass. In some cases, the existence of an asymptomatic adrenal tumor may be discovered during testing for an unrelated condition. Masses discovered incidentally may prompt further testing to analyze hormone levels in the urine and blood. Incidental adrenal gland masses may simply require periodic monitoring and no treatment.
Upon the discovery of a tumor, the individual may be treated with a combination of medications and surgery. In most instances, the mass must be surgically removed to prevent complications. Prescription medications, such as beta- and alpha-blockers, may be recommended to lower blood pressure and regulate heart rate. Once the individual is stabilized through the use of prescription medications, he or she may be scheduled for surgery to remove the pheochromocytoma.
The surgical procedure involves the complete removal of the tumor and affected adrenal gland. In instances where both adrenal glands are affected by the mass' presence, both glands may be removed, requiring the administration of hormone replacement therapy. The removal of the tumor and affected gland may be performed through either an open surgery or laparoscopically. The surgical approach utilized is dependent on the location and size of the mass. For some individuals, surgically removing the mass may not be an option.
If the adrenal mass has been determined to be malignant, treatment may extend beyond surgery and a prescription medication regimen. When the cancer has spread to other parts of the body or has grown aggressively, affecting surrounding tissues, treatment may involve the administration of chemotherapy and radiation. Treatment options for individuals with a malignant tumor that has metastasized are dependent on the aggressiveness, extent and location of the tumor, and the overall health of the individual.
The presence of a benign pheochromocytoma may increase an individual’s risk of damage to his or her internal organs. When high blood pressure is left untreated, the functionality of all the body's major organs becomes jeopardized. Individuals with untreated high blood pressure are at an increased risk for developing complications that include seizures, organ failure, and psychosis. Excessive exposure to high hormone levels, as associated with a pheochromocytoma, may contribute to the development of diabetes and congestive heart failure.