For four months, Ms Indu was not like her regular jolly self. She has put on nearly 20 kilos, and she is unrecognisable.
‘Ahhh… Indu! I almost couldn’t recognise you. How have you been?’
They are polite not to address the elephant in the room. However, their body language goes unnoticed by Ms Indu.
On the other hand, there are also other unsolicited comments from less tactful friends, ‘Indu! What happened? You put on weight! You must be enjoying your food these days!’
To which Ms Indu musters up a fake smile and pretends she is unbothered by the remarks. However, she feels frustrated deep inside. Jaded, a sense of self-loathing.
On most days, she wakes up feeling tired and lethargic. There is another bruise on her knee. Could it have been from bumping into the dining table?
Or perhaps the corner of her son’s desk.
However, it wasn’t that painful. Could it have caused it?’
The diets her friends recommended did not work. She had no energy to go for daily walks. She visited Dr Lee, her family doctor. She begins explaining her plight to Dr Lee.
‘Why am I gaining so much weight?’
Instead of chalking it up to poor eating and lifestyle habits, Dr Lee senses something amiss. He gets her blood taken. A random blood glucose monitor reading shows that she has diabetes mellitus.
‘Ms Indu, when was the last time you had your blood pressure taken? It is rather high.’
These all come as a shock to her. Previously in the pink of health, she is now diagnosed with hypertension, too.
He refers her to his friend, Dr Suhaila, an endocrinologist. After further testing and imaging, Ms Indu has an adenoma – a benign adrenal tumour.
The Adrenal Glands
Before we dive into what an adenoma is, let us look at what adrenal glands and their roles.
They are a pair of organs sitting on our kidneys. Weighing only 4 to 5 grams and measuring 5 cm by 2 cm in length, these triangular-shaped organs make hormones such as adrenaline, noradrenaline and steroids.
Here are some examples of steroid hormones our adrenal glands produce:
- Glucocorticoids – cortisol (regulates blood sugar levels, blood pressure, sleep-wake cycle, suppresses inflammation)
- Aldosterone – regulates blood pressure and electrolytes like potassium and sodium.
- Sex hormones – androgens (male sex hormones – which give men their deep voices, facial and body hair) and oestrogen (female sex hormones – which are responsible for female development and reproduction)
In summary, the adrenal glands produce hormones that regulate metabolism, blood pressure, stress and male/female physical traits/development.
Adrenal Tumours
These growths can be either malignant (cancerous) or benign (non-cancerous).
What causes them? Let us dive into the different types of tumours:
Malignant Tumours
- Adrenocortical cancer
This form of cancer is rare. It mainly affects children under 5 and adults in their 40s to 50s.
There are two types:
- Functioning cancer, which accounts for 70% of cases. These tumours secrete hormones (androgens, cortisol, aldosterone), so patients often present with symptoms; and
- Non-functioning cancer, where patients often do not present with symptoms, as these tumours do not produce hormones. Fret not! If detected early, the prognosis is good.
- Malignant adrenal pheochromocytoma
This form of cancer is also rare, with only 10 – 15 % of pheochromocytomas being cancerous. Pheochromocytomas are the growth of cells that arise from nerve cells called chromaffin cells in the adrenal glands.
Your doctor can determine if it is cancerous based on whether the tumour spreads to surrounding tissues or other organs. People are often initially diagnosed with high blood pressure or have an incidental finding of a mass on the adrenal gland.
- Malignant paragangliomas
They are also a growth of chromaffin cells but outside the adrenal glands. While they can occur at any age, they more commonly affect adults between 30 and 50.
Paragangliomas produce catecholamines, such as adrenaline. The people affected often present with symptoms like dizziness, a rapid heartbeat, heart palpitations (feeling like the heart is pounding out of the chest), sweating, and tremors.
Benign Tumours
The majority of adrenal tumours are benign. Interestingly, most benign tumours don’t cause symptoms and can be incidentally found on radio imaging (CT scans or Magnetic Resonance Imaging (MRI)).
- Adrenal Adenoma
Remember the story of Ms Indu? This benign tumour is the most common type of adrenal growth.
Like Ms Indu, people often present with weight gain, high blood pressure, easy bruising, tiredness and lethargy, muscle weakness, diabetes mellitus and low mood. However, some people do not have any symptoms, because the tumour does not produce hormones.
- Benign pheochromocytoma
These symptoms come suddenly, lasting from minutes to an hour. Pheochromocytomas secrete catecholamines like adrenaline and noradrenaline.
They are similar to malignant pheochromocytomas. These tumours can cause high blood pressure, tremors, headache, fast heartbeat, and sweating.
- Benign paragangliomas
People typically present with symptoms similar to malignant paragangliomas. They are also rare as well.
- Cushing’s Syndrome
It is a medical condition. Our body releases too much cortisol. Cortisol is a stress hormone produced in the adrenal gland. It is an essential hormone that regulates blood pressure, metabolism, inflammation, blood glucose levels, salt and water retention in the body and more.
What causes Cushing’s syndrome?
It can be due to:
- A tumour in the adrenal glands
- Prolonged use of corticosteroids for conditions like asthma or chemotherapy
- A tumour in the pituitary gland ( an organ situated in the brain)
Who Is At Risk?
You may be at risk if you have
- Inherited syndromes
- Multiple Endocrine Neoplasia type 2 (MEN2)
- Li-Fraumeni syndrome
- Neurofibromatosis type 1
- Von Hippel-Lindau disease (VHL)
- Family history of adrenal tumours
- History of adrenal tumour that was surgically removed.
If you or your family members have a history of adrenal tumours, you should consider genetic testing. It is a useful tool to assess your risk of developing adrenal tumours in the future.
Signs and Symptoms
If you have any of these symptoms, you may want to consult a doctor :
- High blood pressure
- Diabetes mellitus
- Unintentional weight gain
- Women: excess facial hair, deep voice, acne, menstruation issues
- Men: breast enlargement, erectile dysfunction or low libido
- Easy bruising
- Lethargy and tiredness
- Depressed mood
- Muscle cramps and spasms
- Sleep disorders, poor sleep
- Round, moon-shaped face
- Purple striae around the abdomen area
- Slow healing wounds
- Fast heartbeat
- Heart palpitations
- Sweating
- Tremors
- Feeling anxiety/fear
How Does It Get Diagnosed?
Your doctor will run some tests to confirm and rule out other diagnoses. It’s a challenging task to diagnose adrenal gland tumours.
Your doctor may refer you to an endocrinologist specialising in adrenal tumours for further testing and a second opinion.
Some tests that your doctor may do to diagnose and confirm the presence of an adrenal tumour and/or guide treatment after diagnosis include:
- Genetic testing – namely if you have a family history of adrenal disorders/tumours
- Blood tests
Depending on the symptoms presented, your doctor will want to assess your plasma potassium, sodium, cortisol, plasma metanephrines, sex hormones like dehydroepiandrosterone (DHEA) or oestrogen and more.
- Urine tests- 24-hour urine testing is often carried out.
- Radio imaging
- CT (computed tomography) /MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scan
These help provide a better visual of the adrenal glands to detect any growths and to check if cancerous growths have spread to other parts of the body.
Your doctor will also use these reports/results to monitor your progress throughout treatment.
I Have an Adrenal Tumour. What Now?
An endocrinologist, oncologist and surgeon may be part of the team treating you; depending on whether the adrenal growth is cancerous or not.
Surgery
Your doctor might suggest surgery to remove one or both adrenal glands. In most cases, a laparoscopic procedure is used since it’s safe, less invasive, and helps you recover more quickly with a shorter hospital stay and fewer complications, like bleeding.
If your lymph nodes are enlarged, your doctor may also remove them to check if the cancer has spread.
Medications
Chemotherapy may be recommended if the cancer has spread (metastasised) to other parts of the body. It can be given through a vein or taken as a pill.
Suppose you have Cushing’s syndrome due to long-term glucocorticoid use. In that case, your doctor may recommend gradually reducing your medication while still managing the underlying condition that required you to take it in the first place.
Radiation therapy
This therapy uses high-energy X-ray beams to target and destroy cancer cells.
Seek Medical Advice Today
If you or your loved one have any of the symptoms above, seek help from a medical professional. Early detection is crucial for a good prognosis!
References
- Adrenal Glands https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands [Last assessed 12 September 2024]
- Benign adrenal tumours https://www.mayoclinic.org/diseases-conditions/benign-adrenal-tumors/symptoms-causes/syc-20356190 [Last assessed 12 September 2024]
- Adrenal Tumours https://www.mdanderson.org/cancer-types/adrenal-tumors.html [Last assessed 12 September 2024]
- Adrenal Cancer https://www.mayoclinic.org/diseases-conditions/adrenal-cancer/symptoms-causes/syc-20351026 [Last assessed 12 September 2024]
- Treating Adrenal cancer https://www.cancer.org/cancer/types/adrenal-cancer/treating.html [Last assessed 12 September 2024]
- Adrenal Cancer https://www.mayoclinic.org/diseases-conditions/adrenal-cancer/diagnosis-treatment/drc-20446405 [Last assessed 12 September 2024]