Adrenal gland cancer causes symptoms and whether it is hereditary

Adrenal gland cancer is a rare and serious disease that affects the gland located above the kidneys, which is responsible for secreting important hormones for the body. This disease is known for its ability to impact blood pressure, weight, and body energy levels, and may be linked to certain genetic factors. In this article by Daly Medical, we will explore the causes of adrenal gland cancer, risk factors, and whether it can be hereditary, helping you understand the disease and detect it early before symptoms worsen.

What is Adrenal Gland Cancer?

Adrenal gland cancer occurs when the cells of the adrenal gland undergo abnormal growth, forming a tumor. You have two adrenal glands, located above each kidney, responsible for producing vital hormones that regulate blood pressure, metabolism, and hormonal balance in the body. Cancer can affect one or both adrenal glands.

How Common is Adrenal Gland Cancer?

Adrenal gland cancer is a very rare condition, affecting around 200 people in the United States each year.

Is Adrenal Gland Cancer Treatable?

Yes, treatment is possible if the tumor is confined to the adrenal gland without spreading to other organs. Surgery, known as adrenalectomy, is the primary treatment. If the cancer has spread beyond the adrenal gland, the chances of a cure are reduced, but treatment can help slow tumor growth and improve quality of life.

How Quickly Does Adrenal Gland Cancer Spread?

The speed of spread depends on the type of tumor:

Adrenocortical carcinoma: The most common type, grows and spreads quickly.
Pheochromocytomas: Some grow slowly, while others grow rapidly.
Ganglioneuromas: Most grow slowly.

The cancer's impact varies from person to person, so it's essential to consult a doctor for individual case evaluation.

How Dangerous is Adrenal Gland Cancer?

Adrenal gland cancer can be difficult to treat, depending on:

Tumor size
Location
Spread to other organs

Survival Rate for Adrenal Gland Cancer

Survival chances depend on the stage at diagnosis:

Early stages (I and II): 50%-60% survival rate over 5 years
Advanced stages (III and IV): 10%-20% survival rate over 5 years

Can Adrenal Gland Cancer Be Prevented?

There is no guaranteed way to prevent adrenal gland cancer. However, avoiding risk factors like smoking may reduce the overall likelihood of developing the disease.

Where Does Adrenal Gland Cancer Spread?

Adrenal gland cancer can spread to other parts of the body, particularly:

Nearby organs: liver, lungs, lymph nodes
Bones: spine and ribs
Distant organs: brain

Tumor spread can cause different symptoms depending on the location, such as pain, weakness, or neurological symptoms. The rate of spread depends on the cancer stage, tumor size, location, and factors like the patient’s age and overall health.

Is Adrenal Gland Cancer Hereditary?

In some cases, particularly in children or with a family history, the tumor may be linked to genetic syndromes. However, most cases occur without any known genetic cause.

Can You Recover from Adrenal Gland Cancer?

Recovery depends on the cancer stage at diagnosis:

Early stages (I and II): Higher chance of recovery
Advanced stages (III and IV): Treatment often focuses on controlling the disease and improving quality of life

How Common is Adrenal Gland Cancer?

No, it is very rare.

Adrenocortical carcinoma: More common in adults
Neuroblastoma: More common in children

Does Adrenal Gland Cancer Affect Hormones?

Yes, many tumors secrete excess hormones, causing:

High blood pressure
Weight gain
Excessive hair growth
Menstrual disturbances

Can the Disease Be Detected Early?

Yes, by noticing hormonal symptoms or unusual high blood pressure. Regular checkups and hormonal tests can aid in early diagnosis.

What’s the Difference Between Benign and Malignant Tumors in the Adrenal Gland?

Benign tumor: Does not spread, typically causes no severe symptoms, and can be easily removed.
Malignant tumor (cancer): Can invade surrounding tissues or spread to distant organs, requiring more comprehensive treatment.

Can the Disease Return After Treatment?

Yes, even after successful surgery or treatment, there is a possibility of recurrence. Regular follow-ups are crucial.

Does the Patient Need Hormonal Medication After Surgery?

Some patients may need steroid replacements if the adrenal gland is entirely removed or if the function of the other gland is affected.

Is Pheochromocytoma Dangerous During Surgery?

Yes, it can cause a sudden rise in blood pressure during surgery. Therefore, pre-surgery preparation with alpha and beta-blockers is necessary.

Can Children Fully Recover?

In cases of early neuroblastoma in children, good recovery can be achieved with surgery and chemotherapy. Ongoing monitoring is vital to prevent recurrence.

Does the Disease Affect Daily Life?

Yes, especially if the tumor secretes excessive hormones or has spread. However, adhering to:

Medical advice
Proper nutrition
Suitable physical activity

can help improve daily life and overall quality of life.

Types of Adrenal Gland Cancer:

1️⃣ Adrenocortical Carcinoma (ACC)
Arises from the outer layer of the gland. It’s the most serious and significant type of adrenal cancer.

Can be hormone-secreting
Can be non-hormone secreting

2️⃣ Malignant Pheochromocytoma
Arises from the adrenal medulla.

Secretes adrenaline and noradrenaline
Often benign, but turns malignant when it spreads

3️⃣ Neuroblastoma
Common in children, arising from immature nerve cells.

One of the most common adrenal-related cancers in children.

4️⃣ Adrenal Lymphoma
A cancer of the lymphatic system.

Rarely originates in the adrenal gland
Usually affects both glands

5️⃣ Adrenal Metastases
Not a primary adrenal cancer, but spreads to the adrenal glands from other organs such as:

Lungs (most common)
Breasts
Kidneys
Colon

Causes of Adrenal Gland Cancer:

1️⃣ Genetic Mutations (Primary Cause)
Mutations in genes responsible for cell division regulation and DNA repair lead to abnormal growth and cancer transformation.

2️⃣ Genetic Factors (Inherited Causes)
Certain genetic syndromes increase the risk, such as:

Li-Fraumeni Syndrome
MEN1 Syndrome
Beckwith-Wiedemann Syndrome
A family history increases the likelihood.

3️⃣ Chronic Hormonal Imbalance
Long-term disorders in hormone secretion, such as:

Cortisol
Aldosterone
Sex hormones
Increase pressure on adrenal cells, raising the risk of cancer transformation.

4️⃣ Radiation Exposure
Especially therapeutic radiation during childhood or repeated high doses.

5️⃣ Weakened Immune System
Includes:

Organ transplant recipients
Immunocompromised patients
Long-term chemotherapy treatments

6️⃣ Age
More common in:

Children under 5 years old
Adults between 30 and 50 years old

7️⃣ Gender
Some types are more common in women than in men.

8️⃣ Smoking (Contributory Factor)
Smoking increases genetic mutations and weakens the immune system, though it’s not a direct strong cause.

9️⃣ Neglected Benign Gland Tumors
Some benign tumors, if not monitored, may transform into malignant ones.

???? Unknown Causes
A large number of cases occur without a clear direct cause.

How is Adrenal Gland Cancer Diagnosed?

1️⃣ Medical History and Clinical Examination
The doctor asks about symptoms such as:

Severe fatigue
Weight gain in the face or abdomen
High blood pressure
Excessive hair growth
Menstrual irregularities
Headaches or sweating
Checking blood pressure and pulse
Palpating the abdomen to detect mass or gland enlargement

2️⃣ Laboratory Tests
Blood and urine tests for hormones such as:

Cortisol: To check for Cushing's syndrome
Aldosterone: To check for blood pressure disorder
Androgens and Estrogens: To assess hormone imbalances
Catecholamines and their metabolites: For pheochromocytoma

Additional tests may include:

Blood sugar and cholesterol
Liver and kidney function tests

3️⃣ Imaging and Medical Scans

CT scan: To determine tumor size and spread
MRI: To differentiate between tumor and surrounding blood vessels or tissues
Nuclear scans (MIBG or PET scan): To detect pheochromocytomas or metastases

4️⃣ Biopsy
Occasionally used to confirm diagnosis in rare cases.

Usually not used for pheochromocytomas due to the risk of high blood pressure.

5️⃣ Genetic Testing
Especially in children or with a family history, to detect genetic syndromes like:

Li-Fraumeni
MEN1
Beckwith-Wiedemann

6️⃣ Cancer Spread Assessment
Checking nearby lymph nodes and investigating distant organ metastases like the lungs, liver, bones, and brain using CT, MRI, or PET scans.

Symptoms of Adrenal Gland Cancer

1️⃣ General Symptoms:

Severe fatigue and general weakness
Sudden unexplained weight loss
Abdominal or back pain due to tumor size
Loss of appetite
Mild fever occasionally

2️⃣ Symptoms of Hormonal Overproduction:

Increased Cortisol (Cushing’s Syndrome):
- Central obesity (increased fat in face and abdomen)
- Muscle weakness
- Osteoporosis (bone fragility)
- High blood sugar levels
- Easy bruising and slow wound healing
Increased Aldosterone:
- High blood pressure
- Low potassium → muscle cramps, irregular heartbeat
Increased Androgens in Women:
- Excessive body and facial hair growth
- Deepening voice
- Irregular or absent menstruation
Increased Estrogens in Men:
- Gynecomastia (breast enlargement)
- Decreased sexual ability

3️⃣ Symptoms of Pheochromocytoma (Adrenal Tumor):

Sudden high blood pressure episodes
Palpitations (fast heart rate)
Severe headaches
Excessive sweating
Feelings of anxiety or panic

⚠️ Episodes may be intermittent and sudden.

4️⃣ Symptoms of Neuroblastoma in Children:

A palpable mass in the abdomen
Bone pain if the tumor has spread to the skeletal system
Persistent fever
Weight loss and decreased activity levels

5️⃣ Symptoms of Cancer Spread to Other Organs:

Lungs: Cough, shortness of breath
Liver: Yellowing of skin and eyes (jaundice), abdominal pain
Bones: Severe pain, fractures
Brain: Persistent headaches, seizures, weakness

Stages of Adrenal Gland Cancer

✅ Stage I (Stage 1)

The tumor is confined to the adrenal gland only.
Size ≤ 5 cm.
No spread to nearby lymph nodes or distant organs.

✅ Stage II (Stage 2)

The tumor is confined to the adrenal gland.
Size > 5 cm.
No spread to nearby lymph nodes or distant organs.

✅ Stage III (Stage 3)

Tumor has spread to nearby lymph nodes.
It may invade nearby organs or tissues, such as the kidneys, large blood vessels, abdominal muscles, or fat.
No spread to distant organs (lungs, liver, bones).

✅ Stage IV (Stage 4)

Tumor has spread to distant organs, including the lungs, liver, bones, or brain.
May or may not involve lymph node metastasis.

Complications and Damage of Adrenal Gland Cancer

✅ 1. General Body Damage:

Persistent fatigue
Significant unexplained weight loss
Loss of appetite
General body weakness
Anemia (low red blood cells in some cases)
Abdominal or back pain due to tumor pressure

✅ 2. Damage Due to Hormonal Imbalance:

Increased Cortisol:
- Fat accumulation in the face and abdomen
- Severe muscle weakness
- Bone fragility
- High blood sugar levels
- Weakened immunity
Increased Aldosterone:
- High blood pressure
- Low potassium → muscle cramps and irregular heartbeat
Increased Androgens in Women:
- Excess body hair growth
- Deepening of voice
- Menstrual irregularities
Increased Estrogens in Men:
- Gynecomastia
- Decreased sexual ability

✅ 3. Complications from Tumor Spread:

Lungs: Shortness of breath, chronic cough
Liver: Liver failure, jaundice (yellowing of skin and eyes)
Bones: Severe pain, fractures
Brain: Persistent headaches, seizures, movement disorders

✅ 4. Psychological Damage:

Severe anxiety
Depression
Constant fear about the future
Sleep disturbances

✅ 5. Side Effects from Treatment:

Nausea and vomiting
Hair loss
Weakened immunity
Chronic fatigue
Varies depending on treatment type and the patient's condition

✅ 6. Most Dangerous Potential Complications:

Sudden hypertensive crises (very high blood pressure)
Severe heart arrhythmias (irregular heartbeats)
Blood clots
Sudden hormonal failure
In late stages: Risk of death

Surgical Treatment for Adrenal Gland Cancer

1️⃣ Adrenocortical Carcinoma (ACC)

Open Surgery:
Removal of the tumor and adrenal gland using traditional surgery.
Used for large tumors (>6 cm) or when there is invasion of surrounding tissues or blood vessels.
Goal: To remove the tumor completely without leaving any cancer cells behind.
Laparoscopic Surgery:
Removal of the adrenal gland via small incisions.
Used for small tumors (<6 cm) with no surrounding tissue invasion.
Advantage: Shorter recovery time and less pain.
Disadvantage: Harder to control if the tumor is large or attached to blood vessels.
Partial Adrenalectomy:
Removal of part of the adrenal gland while preserving the function of the other gland.
Used when the tumor is small and only affects one adrenal gland, especially in children or patients with only one functional gland.

2️⃣ Pheochromocytoma (Adrenal Tumor)

Open Surgery:
Used for large or metastatic tumors.
Pre-surgical preparation: Alpha-blockers followed by beta-blockers to control high blood pressure.
Laparoscopic Surgery:
Used for small, stable tumors.
Advantage: Faster recovery and less pain.

3️⃣ Neuroblastoma in Children

Complete Tumor Resection:
If the tumor is confined to the adrenal gland, the goal is to remove all cancerous cells.
Palliative Surgery:
If the tumor has spread, surgery aims to reduce tumor pressure and alleviate symptoms.
Often combined with chemotherapy.

4️⃣ Adrenal Lymphoma

Surgery is usually not the primary treatment.
Surgery is only used to:
- Take a biopsy to confirm diagnosis.
- Relieve tumor pressure on surrounding organs.

5️⃣ Metastatic Cancer to the Adrenal Gland

Surgery may sometimes be used to relieve symptoms or remove a single tumor if it is localized.
The primary treatment is usually systemic therapy (chemotherapy or immunotherapy).

What to Do and What Not to Do?

✅ What to Do:

Follow your treatment plan: Take all medications as prescribed and attend appointments for checkups and tests.
Monitor blood pressure and hormones regularly.
Maintain a balanced diet: Include vegetables, fruits, and enough protein.
Engage in light physical activity like walking or relaxation exercises.
Seek psychological support: Talk to family members or join support groups.
Practice infection prevention: Wash hands, avoid sick individuals, get vaccines.
Be aware of new symptoms: Monitor for headaches, palpitations, pain, weakness, or bleeding.
Manage medications and hormones as instructed by your doctor.
Organize your daily life: Ensure adequate sleep and rest.

❌ What Not to Do:

Do not stop or change your treatment without consulting your doctor.
Do not ignore elevated blood pressure or new symptoms.
Avoid excessive salt, sugar, and unhealthy food.
Do not overexert yourself physically without consulting your doctor.
Avoid complete isolation or bottling up emotions.
Do not stay in crowded places or interact with infected patients without protection.
Never adjust medication doses or stop taking medications without medical advice.
Avoid overworking or engaging in strenuous activities without adequate rest.
Do not believe in unreliable or incorrect information from unverified sources.

Diagnosis of Adrenal Gland Cancer

1️⃣ Medical History and Clinical Examination:

The doctor will inquire about symptoms such as fatigue, weight loss, high blood pressure, excessive hair growth, menstrual irregularities, headaches, or sweating.
Blood pressure and pulse examination.
Abdominal exam to detect any mass or enlargement in the adrenal gland.

2️⃣ Laboratory Tests:

Hormone tests in blood and urine:
- Cortisol: To check for Cushing’s syndrome.
- Aldosterone: To assess blood pressure disorders.
- Androgens and Estrogens: To check for excessive sexual hormones.
- Catecholamines and metabolites: To detect pheochromocytoma.
Additional tests, depending on the case:
- Blood sugar and cholesterol levels.
- Liver and kidney functions.

3️⃣ Imaging and Medical Scans:

CT Scan: To assess tumor size and spread.
MRI: To distinguish between tumors and surrounding blood vessels or soft tissues.
Nuclear Imaging (MIBG or PET Scan): To detect pheochromocytomas or metastases.

4️⃣ Biopsy:

Sometimes used to confirm the diagnosis in rare cases.
- Usually not used for pheochromocytomas due to the risk of high blood pressure during biopsy.

5️⃣ Genetic Testing:

Especially important for children or those with a family history of adrenal gland cancer.
- Can detect genetic syndromes such as:
  - Li-Fraumeni Syndrome
  - MEN1 Syndrome
  - Beckwith-Wiedemann Syndrome