What are the symptoms of an adrenal mass?

Symptoms of Adrenal Mass

Adrenal masses often present with specific symptoms related to hormone hypersecretion, malignancy, or may be completely asymptomatic when discovered incidentally. 1, 2

Clinical Presentation Categories

Asymptomatic Presentation

• Most adrenal masses (approximately 75%) are benign non-functional adenomas discovered incidentally during imaging for unrelated conditions 1
• These masses typically do not cause symptoms and are termed "adrenal incidentalomas"

Hormone Excess Symptoms

1. Cortisol-Secreting Adenomas (5.3% of adrenal masses) 1

   • Weight gain with central obesity
   • Facial rounding ("moon face")
   • Purple striae on abdomen
   • Buffalo hump (fat pad between shoulders)
   • Proximal muscle weakness
   • Easy bruising
   • Hypertension
   • Glucose intolerance or diabetes
   • Mood changes, depression, or anxiety

2. Aldosterone-Secreting Adenomas (1% of adrenal masses) 1, 2

   • Hypertension (often resistant to treatment)
   • Hypokalemia (low potassium)
   • Muscle weakness or cramping
   • Headaches
   • Polyuria (excessive urination)
   • Polydipsia (excessive thirst)

3. Catecholamine-Secreting Pheochromocytomas (5.1% of adrenal masses) 1, 2

   • Episodic or persistent hypertension
   • Headaches (often severe)
   • Palpitations
   • Profuse sweating
   • Pallor
   • Anxiety or panic attacks
   • Tremors
   • Weight loss
   • Hyperglycemia

4. Androgen-Secreting Tumors 1, 3

   • In females: hirsutism (excessive hair growth)
   • Virilization (deepening voice, male pattern baldness)
   • Menstrual irregularities
   • Acne
   • Increased muscle mass

Malignancy-Related Symptoms

1. Adrenocortical Carcinoma (4.7% of adrenal masses) 1, 4

   • Abdominal or flank pain
   • Palpable abdominal mass
   • Weight loss
   • Early satiety
   • Fever
   • Night sweats
   • May present with hormone excess symptoms (mixed cortisol and androgen production is common)

2. Metastatic Disease (2.5% of adrenal masses) 1, 4

   • Symptoms related to primary malignancy
   • Abdominal or flank pain
   • Weight loss
   • Fatigue

Diagnostic Approach

When an adrenal mass is detected, a thorough clinical evaluation should be performed to identify signs and symptoms of hormone excess or malignancy 1, 2:

1. Focused history looking for:

   • Hypertension (onset, severity, control)
   • Episodes of headache, palpitations, sweating
   • Changes in body habitus
   • Muscle weakness
   • Weight changes
   • Menstrual irregularities in women
   • History of malignancy

2. Physical examination focusing on:

   • Blood pressure measurement
   • Signs of Cushing's syndrome (central obesity, facial plethora, striae)
   • Signs of virilization in women
   • Palpable abdominal mass

Important Considerations

• Even small, radiologically benign-appearing adrenal masses can produce hormones and cause significant morbidity 2, 3
• All patients with adrenal masses should undergo hormonal evaluation regardless of imaging appearance 2
• A multidisciplinary approach involving endocrinologists, surgeons, and radiologists is recommended when the imaging is not consistent with a benign lesion, there is evidence of hormone hypersecretion, or the tumor has grown significantly during follow-up 1, 2

Common Pitfalls to Avoid

• Assuming a small adrenal mass is non-functional without hormonal evaluation
• Attributing non-specific symptoms like hypertension to other causes without considering adrenal hormone excess
• Missing subtle signs of hormone excess during physical examination
• Failing to recognize that approximately 20% of all adrenal incidentalomas are potential surgical lesions 1
• Overlooking the possibility of genetic syndromes in patients with pheochromocytomas (over 35% have germline mutations) 5

Remember that early diagnosis of functional adrenal tumors and adrenocortical carcinoma is crucial for reducing morbidity and improving prognosis 5.