Adrenal carcinoma is a malignancy of the adrenal gland and normally carries a very poor prognosis. These tumors are usually classified by their ability (or sometimes lack of, in the case of nonfunctional tumors) to secrete adrenal hormones, which can cause a variety of symptoms.
Cushing's Syndrome
When the adrenal carcinoma releases excess amounts of corticosteroid, it can result in Cushing's syndrome. The prognosis is usually poor, and the symptoms are typical of corticosteroid excess. They include abdominal striae, rapid weight gain (especially in the trunk and face, with limb sparing present), "buffalo hump" on neck, decreased libido, insomnia, psychiatric manifestations (like depression and anxiety), hyperglycemia (increased blood sugar) and increased blood pressure. Electrolyte abnormalities like decreased potassium can occur in addition to long-term dysfunction, such as osteoporosis. The effects of untreated Cushing's syndrome can usually lead to more disease burden on the patient, which, coupled with the cancer itself, can be quite detrimental to the patient.
Testosterone-Secreting Adrenal Carcinoma
When the tumor releases excess testosterone, virilization can result. This is the exaggeration of male characteristics in females, such as excess facial hair, deep voice, acne on the back, increased muscle size, male pattern baldness and clitoral enlargement. These tumors tend to be smaller and more benign in nature and carry a better prognosis.
Estrogen-Secreting Adrenal Carcinoma
In contrast to testosterone-secreting tumors, these are larger and much more malignant. A typical finding is gynecomastia, in addition to decreased libido, impotence, decrease in testicular size and infertility.
Aldosterone-Secreting tumor
Most of these tumors are quite large and also have a poor prognosis for the patient. Increased levels of aldosterone can result in electrolyte abnormalities such as decreased potassium, which can cause muscle pain, weakness and cardiac abnormalities. There is also a resulting metabolic alkalosis, as well as increased fluid retention by the body, resulting in increased blood pressure.
References
- "Campbell-Walsh Urology, 9th Edition;" Wein; 2007
- Journal of Clinical Endocrinology and Metabolism. "Approach to the Patient with Possible Cushing's Syndrome." Boscaro M, Arnaldi G. Volume 94, Issue 9 (September 2009)
- "Abeloff's Clinical Oncology, 4th Edition;" Abeloff; 2008
