The suprarenal glands, more commonly known as the adrenal glands, are hormone-secreting organs that sit atop your kidneys. These small but important organs secrete an array of hormones, including aldosterone, adrenalin, cortisol and androgens, a type of male sex hormone. Suprarenal tumors are uncommon and most are noncancerous. Several key features help distinguish different types of suprarenal tumors.
Location
Your suprarenal glands contain two regions, the outer cortex and the inner medulla. The cells that make up these regions are distinct and produce different hormones. In evaluating a suprarenal tumor, doctors note whether the mass is located in the adrenal cortex or medulla. This distinction helps guide the medical workup to determine the nature and cause of the tumor.
Functionality
Most suprarenal tumors are functionally inactive; that is, they do not produce hormones. In the absence of hormone production, suprarenal tumors usually cause no symptoms. These growths are often discovered coincidentally on a CT or MRI scan, giving rise to the term "adrenal incidentalomas."
Suprarenal tumors that produce hormones generally cause symptoms of varying severity. The constellation of symptoms that occurs depends on the specific hormone or hormones the tumor produces. Both cancerous and noncancerous suprarenal tumors may produce hormones.
Unilateral or Bilateral
Suprarenal tumors are found in both glands in approximately 2 to 10 percent of cases, according to Drs. Marc Slawik and Martin Reincke. Likely causes of bilateral suprarenal tumors include cancer that has spread from another organ; congenital adrenal hyperplasia, a genetic disorder of the adrenal cortex; and benign tumors of the adrenal cortex. Invasion of the adrenal glands by infectious agents, such as the bacteria that cause TB, can also lead to masses in both suprarenal glands.
Adenomas and Carcinomas
Tumors that arise from cells of the adrenal cortex are either noncancerous adenomas or, less commonly, cancerous adrenocortical carcinomas. The incidence of adrenal adenomas increases with age. Whereas most adrenal adenomas do not produce hormones, up to 80 percent of adrenocortical carcinomas are hormonally active, according to the National Cancer Institute. The most common hormonal symptoms associated with adrenocortical carcinoma relate to an elevated blood cortisol level. Signs and symptoms may include thinning of the skin, purple stretch marks, increased body fat in the abdomen, rounding of the face, weakness, loss of muscle mass, high blood pressure and an elevated blood sugar level. Adenocortical carcinoma is a rare form of cancer, affecting approximately one to two people per million in the U.S. population. Surgical removal is the treatment of choice for adrenocortical carcinomas that have not spread beyond the suprarenal gland. This form of cancer often recurs.
Pheochromocytomas
Tumors that arise from the medullary region of the suprarenal gland are called pheochromocytomas. Approximately 10 to 20 percent of pheochromocytomas are cancerous, according to a July/August 2002 article published in "Cancer Control." These tumors secrete varying amounts of adrenalin and norepinephrine. Common symptoms related to increased blood levels of these hormones include high blood pressure, headaches, fever, excessive sweating, heart palpitations, chest pain, nervousness, nausea, vomiting and paleness. Cancerous pheochromocytomas are rare, affecting roughly two to eight out of every million Americans, reports NCI. Surgery is the treatment of choice for both cancerous and noncancerous pheochromocytomas.
Metastatic Tumors
Cancers that originate in other organs may spread to the suprarenal glands and give rise to tumors. These tumors, known metastatic adrenal tumors, occur with cancers of the lung, breast, kidney, colon, stomach, esophagus, prostate, urinary bladder, uterus, liver, pancreas and gallbladder. Melanoma, a form of skin cancer, can also spread to the suprarenal glands. Because these tumors are composed of tissue from the original cancer site, they do not secrete adrenal hormones. Large metastatic adrenal tumors may overtake the normal tissue of the suprarenal gland, causing abnormally low levels of the adrenal hormones.
References
- "The Merck Manual for Healthcare Professionals"; Overview of Adrenal Function; Ashley B. Grossman, M.D.; October 2007
- Endotext.com; Adrenal Incidentalomas; Marc Slawik, M.D., Martin Reincke, M.D.; October 2010
- "New England Journal of Medicine"; The Incidentally Discovered Adrenal Mass; William F. Young, Jr., M.D.; February 2007
- National Cancer Institute; Adrenocortical Carcinoma Treatment General Information; May 2008
- Endotext.com; Current Issues in the Diagnosis and Management of Adrenocortical Carcinomas; Eva Kassi, M.D., et al.; October 2009
- "The Merck Manual for Healthcare Professionals"; Cushing's Syndrome; Ashley B. Grossman, M.D.; November 2007
- "Cancer Control"; Evaluation and Management of Adrenal Masses; Sergio Gugisch Moreira, Jr., M.D., Julio M. Pow-Sang, M.D.; July/August 2002
- Endotext.com; Pheochromocytoma; Marybeth S. Hughes, M.D., et al.; March 2010
- National Cancer Institute; General Information About Pheochromocytoma and Paraganglioma; October 2010
