Symptoms of Adrenal Tumors in Elderly Women
Elderly women with adrenal tumors most commonly present with hypertension, hypokalemia, and signs of hormone excess—particularly from cortisol, aldosterone, or androgens—though many tumors are discovered incidentally without symptoms.
Hormone-Secreting Tumor Presentations
Cortisol-Secreting Tumors (Cushing Syndrome)
The most common functional presentation includes 1:
- Hypertension (often resistant to treatment)
- Hyperglycemia and new-onset or worsening diabetes
- Hypokalemia with metabolic alkalosis
- Muscle atrophy and weakness
- Central obesity, moon facies, and buffalo hump
- Easy bruising and thin skin
- Osteoporosis and fractures
Aldosterone-Secreting Tumors (Primary Aldosteronism/Conn Syndrome)
These tumors characteristically cause 1, 2:
- Hypertension (often severe and difficult to control)
- Hypokalemia causing weakness and fatigue
- Metabolic alkalosis
- Polyuria and polydipsia
- Muscle cramps
- Dependent edema (may be labeled "idiopathic" edema) 3
Pheochromocytomas (Catecholamine-Secreting)
Present with adrenergic symptoms 1:
- Episodic or sustained hypertension
- Paroxysmal headaches
- Palpitations and tachycardia
- Diaphoresis (excessive sweating)
- Anxiety and tremor
- Pallor during episodes
Androgen/Estrogen-Secreting Tumors
Rare but important presentations in elderly women 4, 5, 6:
- Virilization: hirsutism, deepening voice, male-pattern baldness, clitoromegaly 5, 6
- Postmenopausal vaginal bleeding (estrogen-secreting tumors) 4
- Bilateral breast enlargement (estrogen-secreting tumors) 4
- Acne and increased muscle mass
- Elevated testosterone (>200 ng/dL) and DHEAS (>6,600 ng/ml) suggest virilizing adenoma 6
Non-Functional Tumors (Adrenal Incidentalomas)
Many adrenal tumors in elderly women are discovered incidentally and may be asymptomatic 1:
- Found on imaging performed for unrelated reasons
- No obvious hormonal symptoms
- May still have subclinical autonomous cortisol secretion causing subtle metabolic abnormalities 1
- Progressive metabolic comorbidities (hypertension, diabetes, osteoporosis) may be the only clue 1
Malignant Adrenal Tumors (Adrenocortical Carcinoma)
Suspect malignancy with 1:
- Large tumor size (>4-5 cm)
- Irregular margins or heterogeneous appearance
- Local invasion or lymphadenopathy
- Mixed hormone secretion patterns 4
- Rapid symptom progression
- Abdominal/flank pain or palpable mass
- Constitutional symptoms: weight loss, fatigue, fever
Critical Diagnostic Approach
All elderly women with adrenal tumors require systematic hormonal screening 1:
Screen for autonomous cortisol secretion using 1 mg dexamethasone suppression test (all patients) 1
Screen for primary aldosteronism if hypertension and/or hypokalemia present using aldosterone-to-renin ratio 1
Screen for pheochromocytoma with plasma or 24-hour urinary metanephrines if:
Screen for androgen excess if virilization signs present or adrenocortical carcinoma suspected 1, 4
Common Pitfalls to Avoid
- Don't assume asymptomatic means non-functional: Subclinical hormone excess is common and contributes to metabolic disease 1
- Don't miss pheochromocytoma: Failure to diagnose preoperatively can cause fatal hypertensive crisis during surgery 3
- Don't overlook subtle virilization: In elderly women, mild hirsutism may be attributed to aging rather than tumor 5, 6
- Don't ignore "idiopathic" edema: This may represent undiagnosed aldosterone excess 3
- Feminizing tumors are almost always malignant in women and require aggressive evaluation 4