Adrenal Tumor Diagnosis and Treatment

What is a sex-hormone producing adrenal tumor?

Sex-hormone producing adrenal tumors are very rare and occur in about 2 out of every 1 million people. These tumors may be benign or cancerous. Telling the difference between a benign and a cancerous sex-hormone producing tumor may be difficult. The best predictor of cancer is whether or not there is spread to other organs (metastases), invasion of other organs, or recurrence after surgery. Smaller tumors are more typically benign, whereas larger tumors pose a greater risk of being cancer.

Signs and Symptoms

The signs and symptoms of sex-hormone producing adrenal tumors can be divided into three categories:

Androgen secreting tumors — In young boys, these tumors can lead to early onset of puberty. In females of any age, these tumors can lead to deepening of the voice, increased hair growth, increased acne, increased muscle mass, indistinct genitalia, and enlargement of the clitoris.

Estrogen secreting tumors — These tumors may or may not cause symptoms depending on the age and sex of the patient. In young boys, they can cause breast enlargement, delayed or absent pubic hair, delayed penis growth. For older males, they can lead to breast enlargement, decreased sperm production, decreased pubic hair, and testicle and penis shrinking. In girls who have not reached puberty, these tumors can lead to early puberty and early start of periods. Premenopausal women may experience abnormal periods. Postmenopausal women may develop vaginal bleeding.

Mixed androgen and estrogen secreting tumors — Occasionally tumors may produce a combination of estrogens and androgens. Tumors that secrete a combination of estrogens, androgens, and cortisol are more likely to be cancerous.

Diagnosis and Radiological Tests

A thorough examination by a physician is the first step in the evaluation of a suspected sex-producing adrenal tumor. Blood and urine tests looking for different types of androgens (i.e. testosterone) and estrogen are used to confirm the diagnosis. Once the diagnosis is made, CAT scan or MRI should be used to locate any adrenal tumor and rule out an ovarian or testicular source.

Treatment

Complete surgical removal of the tumor is the only treatment that can potentially cure people with sex hormone producing adrenal tumors. Due to the increased risk of malignancy, these tumors are often removed through a traditional “open” operation (adrenalectomy). In addition, sex-hormone producing adrenal cancers have a risk of spreading to surrounding lymph nodes. Removing the lymph nodes in the region of the tumor should be considered for patients with findings suspicious for cancer. With large or invasive cancers, complete surgical removal may not be possible, and the patient may need chemotherapy or other medications to control the disease. The prognosis is improved in younger patients and in those with a complete surgical removal of the tumor. Symptoms typically improve after removal of the tumor.