What type of doctor treats a patient with an adrenal gland tumor?

Specialist Management of Adrenal Gland Tumors

Patients with adrenal gland tumors require evaluation and management by a multidisciplinary expert team that includes endocrinologists for hormonal assessment and medical management, surgeons with specific expertise in adrenal surgery, medical oncologists for systemic therapy when indicated, and specialized pathologists for tissue diagnosis. 1

Primary Specialists Involved

Endocrinologist

• The endocrinologist serves as the central coordinator for initial evaluation, performing comprehensive hormonal work-up to identify autonomous cortisol, aldosterone, or catecholamine excess, and managing perioperative medical optimization. 1
• All patients with suspected adrenocortical carcinoma or pheochromocytoma must undergo biochemical confirmation before any intervention, as unrecognized tumors can cause life-threatening crises. 2
• The endocrinologist guides long-term surveillance protocols, particularly for patients with hereditary syndromes or high-risk features. 2

Specialized Adrenal Surgeon

• Adrenal surgery must be performed only by surgeons with appropriate expertise and experience, with guidelines suggesting a minimum annual workload of 6 adrenalectomies per year, but preferably >20 surgeries per year. 1
• In addition to expertise in adrenal surgery, sufficient experience in oncological surgery is essential for managing adrenocortical carcinoma. 1
• The entire operative team, including anesthesiologists, should be well-trained in adrenal surgery to optimize outcomes. 1

Medical Oncologist

• Medical oncologists are essential team members for patients with adrenocortical carcinoma requiring systemic therapy with mitotane and/or cytotoxic chemotherapy. 3
• Oncologists guide treatment decisions for advanced or recurrent disease, including consideration of clinical trials. 1

Additional Specialists

• Specialized endocrine pathologists must perform histological diagnosis, as accurate pathological assessment using Weiss scoring (≥3 for adrenocortical carcinoma) and Ki-67 index is critical for risk stratification. 1
• Radiation oncologists may be consulted for adjuvant radiation therapy to the tumor bed in high-grade adrenocortical carcinoma, particularly with concern for tumor spillage or close margins. 1
• Geneticists should be involved when hereditary syndromes are suspected, as approximately one-third of pheochromocytomas are inherited. 2
• Specialized radiologists are needed for proper imaging interpretation and guidance of functional imaging studies. 3

Multidisciplinary Team Approach

• All patients with suspected and proven adrenocortical carcinoma or pheochromocytoma/paraganglioma should be discussed in a multidisciplinary expert team meeting, at minimum at initial diagnosis and with progressive disease. 1
• For patients in remote locations, follow-up by the local healthcare provider should occur in collaboration with a multidisciplinary team at an expert adrenal tumor program. 3

Critical Pitfalls to Avoid

• Never perform fine needle biopsy of suspected pheochromocytoma before biochemical exclusion, as this can precipitate fatal hypertensive crisis. 2
• Biopsies of suspected adrenocortical carcinoma are usually not informative and should be avoided. 1
• Do not initiate beta-blockade alone in suspected pheochromocytoma before alpha-blockade, as this can precipitate severe hypertensive crisis due to unopposed alpha-adrenergic stimulation. 2
• Avoid contrast-enhanced CT in suspected pheochromocytoma due to risk of hypertensive crisis; use MRI preferentially. 2

When to Refer

• Immediate referral to an expert multidisciplinary team is indicated for any adrenal mass >4 cm with irregular margins or internal heterogeneity (suspicious for carcinoma), biochemically confirmed pheochromocytoma, or any hormonally active tumor requiring surgical intervention. 1
• Patients with metanephrine levels ≥4 times the upper limit of normal require immediate imaging and specialist referral. 2
• Young patients (<40 years) with adrenal tumors, those with bilateral tumors, or extra-adrenal tumors should be referred for genetic counseling and specialized evaluation. 1, 2