Can an adrenal adenoma cause sweating?

Can Adrenal Adenoma Cause Sweating?

Yes, adrenal adenomas can cause sweating, particularly when they are functioning tumors that secrete excess hormones, most notably in pheochromocytomas and certain cortisol-secreting adenomas. 1

Types of Adrenal Adenomas and Their Relationship to Sweating

Adrenal incidentalomas (adrenal masses discovered incidentally) have various presentations, and their ability to cause sweating depends on their hormonal activity:

Pheochromocytoma

• Most strongly associated with sweating as a primary symptom
• Produces excess catecholamines (epinephrine/norepinephrine)
• Classic triad: headaches, sweating, and palpitations 1
• Accounts for 1.5-14% of adrenal incidentalomas 1
• Physical exam may reveal severe hypertension, tachycardia, arrhythmias, congestive heart failure, excessive sweating, anxiety, and pallor 1

Cortisol-Secreting Adenomas

• May cause sweating as part of Cushing's syndrome
• Represents 1-30% of adrenal incidentalomas 1
• Associated symptoms include weight gain, central obesity, easy bruising, hypertension, diabetes, proximal muscle weakness, and sleep disturbances 1

Aldosterone-Producing Adenomas

• Less commonly associated with sweating
• Accounts for 2-7% of adrenal incidentalomas 1
• Primarily presents with hypertension, hypokalemia, muscle weakness 1

Non-functioning Adenomas

• Most common type (71-84% of adrenal incidentalomas) 1
• Do not typically cause sweating or other hormonal symptoms

Diagnostic Approach for Adrenal Adenomas with Sweating

When an adrenal mass is discovered and sweating is a symptom, a systematic approach is needed:

1. Screen for pheochromocytoma first:

   • Plasma free metanephrines or 24-hour urinary metanephrines 1
   • Critical to exclude before any invasive procedures including biopsy 1

2. Screen for cortisol excess:

   • 1 mg overnight dexamethasone suppression test (DST) for all adrenal incidentalomas 1
   • Cortisol >138 nmol/L (>5 μg/dL) after DST indicates hypersecretion 1

3. Imaging characteristics:

   • Non-contrast CT: Benign adenomas typically <10 Hounsfield units 1
   • Pheochromocytomas may have atypical imaging features and can be mistaken for adenomas on washout CT in approximately 1/3 of cases 1

Important Clinical Considerations

• Beware of misdiagnosis: Some conditions can mimic the catecholamine excess of pheochromocytoma, including obstructive sleep apnea 2

• Rare presentations: Some adrenal cortical adenomas can contain adrenalin-type neurosecretory granules, clinically mimicking a pheochromocytoma despite having the histological appearance of an adrenal cortical adenoma 3

• Evolving pathology: Benign adrenal hyperplasia can sometimes develop autonomous nodules over time that behave like hormone-secreting adenomas 4

Management of Symptomatic Adrenal Adenomas

For adenomas causing significant sweating:

• Surgical approach:

  • Laparoscopic adrenalectomy is recommended for functioning adenomas causing symptoms 1
  • Minimally invasive surgery is preferred when feasible 1
  • Special pre-operative preparation is required for pheochromocytoma to prevent hypertensive crisis

• Non-surgical management:

  • For patients with mild autonomous cortisol secretion: treat associated comorbidities and consider surgery if comorbidities are difficult to control 5
  • For non-surgical candidates with aldosterone-producing adenomas: medical management with spironolactone or eplerenone 1

Follow-up Recommendations

• Non-functioning adenomas <4 cm with benign imaging features require no further follow-up 1
• Adenomas ≥4 cm with benign features should undergo repeat imaging in 6-12 months 1
• Growth >5 mm/year warrants consideration of adrenalectomy after repeating functional work-up 1

Remember that sweating as a symptom of adrenal adenoma most strongly suggests pheochromocytoma, which requires prompt diagnosis and treatment to prevent potentially life-threatening complications.