Symptoms of Adrenal Tumors
Hormone-Secreting Tumors
Adrenal tumors can be functional (hormone-secreting) or non-functional, with functional tumors producing distinct clinical syndromes based on the specific hormone being overproduced. 1
Cortisol-Secreting Tumors (Cushing's Syndrome)
- Weight gain with central obesity, moon face, buffalo hump, and purple striae are classic features 2
- Proximal muscle weakness and easy bruising develop from protein catabolism 2
- Hypertension, hyperglycemia, and hypokalemia that may be resistant to standard treatment 3
- Muscle atrophy and osteoporosis occur with prolonged exposure 3
Aldosterone-Secreting Tumors (Conn's Syndrome)
- Resistant hypertension is the hallmark presentation 1, 3
- Hypokalemia with metabolic alkalosis occurs in most cases 1, 3
- Muscle weakness and cramps result from potassium depletion 2
Pheochromocytomas (Catecholamine-Secreting)
- Episodic or sustained hypertension with paroxysmal attacks 3
- Classic triad: paroxysmal headaches, palpitations, and profuse sweating 3
- Anxiety, tremor, and pallor during catecholamine surges 4
- Weight loss may occur in some patients 4
Androgen-Secreting Tumors
- Virilization signs including hirsutism and voice deepening in women 1, 4
- Rapid onset of symptoms suggests adrenocortical carcinoma 1
Non-Functional Tumors
The majority of adrenal tumors (approximately 75%) are benign non-functional adenomas that are asymptomatic and discovered incidentally. 1
Incidental Discovery
- Most non-functional tumors are completely asymptomatic and found during imaging for unrelated conditions 1, 5
- Subclinical autonomous cortisol secretion may be present without overt Cushing's syndrome but can still cause metabolic complications 1, 3
Mass Effect Symptoms
- Abdominal or flank pain occurs with larger tumors (typically >6 cm) 4
- Palpable mass in rare cases of very large tumors 4
- Symptoms related to local invasion in adrenocortical carcinoma 1
Critical Diagnostic Approach
All patients with adrenal tumors require systematic hormonal screening regardless of symptoms, as subclinical hormone excess is common and affects management. 1, 2
Mandatory Screening Tests
- 1 mg dexamethasone suppression test for all patients to detect autonomous cortisol secretion 1, 3
- Aldosterone-to-renin ratio in patients with hypertension and/or hypokalemia 1, 2
- Plasma or 24-hour urinary metanephrines if tumor >10 HU on CT or any adrenergic symptoms present 1, 2
- Serum androgen testing when virilization signs present or adrenocortical carcinoma suspected 1
Key Clinical Pitfalls
- Never assume a tumor is non-functional based on absence of symptoms alone - subclinical hormone excess is present in approximately 20% of "non-functional" tumors 2
- Always screen for pheochromocytoma before any biopsy or surgery to prevent hypertensive crisis 1, 6
- Elderly patients may have atypical presentations with less obvious symptoms despite significant hormone excess 3