What Symptoms Are Associated with Adrenal Gland Cancer?

1. Symptoms Due to Hormonal Imbalance

The adrenal glands are involved in producing hormones such as cortisol, aldosterone, adrenaline, and sex hormones. When a tumor develops in the adrenal glands, it may lead to either an overproduction or underproduction of these hormones, resulting in various symptoms. Some adrenal tumors, even when malignant, may be non-functional, meaning they do not produce excess hormones. However, a significant number of adrenal tumors, including adrenal cancer, are functional and secrete hormones that cause hormonal imbalances, contributing to specific symptoms.

1.1. Cushing’s Syndrome (Excess Cortisol Production)

Cortisol is a hormone that helps the body respond to stress and regulates metabolism, blood sugar, and immune response. When an adrenal tumor produces too much cortisol, it can lead to Cushing’s syndrome, a condition characterized by a variety of symptoms:

• Weight Gain: A hallmark symptom of Cushing’s syndrome is rapid and unexplained weight gain, particularly in the face, neck, and abdomen. This fat accumulation, sometimes called a “moon face” or “buffalo hump,” is due to increased fat storage caused by cortisol.
• Skin Changes: People with Cushing’s syndrome may develop thinning skin that bruises easily, as well as purple or pink stretch marks, particularly on the abdomen, thighs, and arms.
• Muscle Weakness: The excess cortisol interferes with muscle strength, leading to muscle wasting, especially in the arms and legs.
• High Blood Pressure (Hypertension): Elevated cortisol levels can contribute to high blood pressure, which may not respond well to standard treatment.
• Mood Changes: Individuals with Cushing’s syndrome may experience anxiety, depression, and irritability due to the effects of cortisol on the brain.
• Increased Risk of Infections: Cortisol suppresses the immune system, which may make individuals more susceptible to infections.

1.2. Conn’s Syndrome (Excess Aldosterone Production)

Aldosterone is a hormone produced by the adrenal glands that helps regulate salt and water balance in the body, ultimately controlling blood pressure. When an adrenal tumor overproduces aldosterone, it leads to Conn’s syndrome, which can cause the following symptoms:

• High Blood Pressure (Hypertension): One of the primary symptoms of Conn’s syndrome is resistant high blood pressure, often difficult to control with standard antihypertensive medications.
• Low Potassium Levels (Hypokalemia): Aldosterone excess leads to excessive potassium loss through the kidneys, causing symptoms such as muscle weakness, fatigue, cramps, and irregular heart rhythms (arrhythmias).
• Frequent Urination: Increased aldosterone can cause the kidneys to excrete more sodium, which leads to increased thirst and urination.

1.3. Pheochromocytoma (Excess Catecholamine Production)

A pheochromocytoma is a rare adrenal tumor that originates in the adrenal medulla, the inner part of the adrenal glands. This type of tumor produces an excess of catecholamines, including adrenaline and norepinephrine, which can lead to a variety of symptoms:

• High Blood Pressure (Hypertension): Sudden spikes in blood pressure, known as paroxysmal hypertension, are a common symptom of pheochromocytomas. These episodes may be triggered by stress, physical activity, or even changes in posture.
• Tachycardia (Rapid Heart Rate): Increased levels of adrenaline can lead to tachycardia, or a rapid heart rate, often accompanied by palpitations.
• Excessive Sweating: People with pheochromocytoma often experience excessive sweating, even in the absence of physical exertion or heat.
• Anxiety or Panic Attacks: The surge of catecholamines can induce feelings of anxiety, nervousness, or panic, mimicking anxiety attacks.
• Headaches: Persistent or severe headaches may occur as a result of high blood pressure associated with elevated catecholamine levels.
• Tremors: Trembling or shaking, often in the hands, can also occur as a result of excess adrenaline.

1.4. Androgen Excess (Excessive Sex Hormones)

In some cases, adrenal tumors can lead to the overproduction of androgens (male sex hormones) such as testosterone. This is more commonly seen in women and can lead to the following symptoms:

• Hirsutism: Excessive hair growth on areas such as the face, chest, and abdomen in women, typically in a male-pattern distribution.
• Deepening of the Voice: The overproduction of testosterone in women can lead to a deepening of the voice, a condition known as virilization.
• Male-pattern Baldness: Women with androgen excess may also experience thinning hair or male-pattern baldness.
• Menstrual Irregularities: Excess androgens can lead to irregular periods, or in some cases, the absence of menstruation (amenorrhea).

2. Symptoms Due to Tumor Size and Local Effects

In addition to the hormonal effects of adrenal cancer, the tumor’s physical presence can cause symptoms as it grows and exerts pressure on surrounding structures. Larger tumors may lead to noticeable symptoms, particularly if they invade adjacent organs or tissues.

2.1. Abdominal Pain or Discomfort

One of the most common symptoms of adrenal gland cancer is unexplained abdominal pain or discomfort. As the tumor enlarges, it can press on nearby organs, including the liver, intestines, and kidneys, causing pain. This pain is often dull or achy but can become sharp or intense if the tumor ruptures or bleeds.

2.2. Palpable Mass

In some cases, a large adrenal tumor may be palpable during a physical exam. A mass felt in the upper abdomen or flank may be indicative of an adrenal tumor, especially if it is large enough to be easily detected. The mass may or may not be tender to the touch.

2.3. Back Pain

Adrenal cancer can cause pain in the lower back, particularly if the tumor grows large enough to affect the surrounding structures. The pain may be persistent and worsen over time, especially when sitting or standing for extended periods.

2.4. Weight Loss and Fatigue

Unexplained weight loss and fatigue are common systemic symptoms of adrenal gland cancer, particularly when the cancer is advanced. This can occur due to both the metabolic effects of the tumor (e.g., increased cortisol production in Cushing’s syndrome) and the cancer’s progression, which depletes the body’s energy stores.

2.5. Nausea and Vomiting

As the tumor grows and exerts pressure on the stomach or intestines, nausea and vomiting may occur, particularly after eating. These symptoms can be caused by the physical obstruction or irritation of the digestive system by the growing tumor.

3. Symptoms of Metastasis

In advanced stages, adrenal cancer may spread (metastasize) to other parts of the body. When this occurs, symptoms will depend on the site of metastasis.

3.1. Lung Metastasis

If the cancer spreads to the lungs, patients may experience symptoms such as persistent cough, shortness of breath, chest pain, or coughing up blood. Lung metastasis often results in progressive respiratory symptoms as the cancer grows and affects lung function.

3.2. Liver Metastasis

When adrenal cancer spreads to the liver, patients may experience jaundice (yellowing of the skin and eyes), abdominal swelling, or pain in the upper right side of the abdomen. Hepatic metastasis can cause liver dysfunction, leading to systemic symptoms such as nausea, vomiting, and loss of appetite.

3.3. Bone Metastasis

If the cancer spreads to the bones, patients may develop bone pain, fractures, and a higher risk of skeletal complications. Bone metastasis can result in severe discomfort and limited mobility.

4. Early Detection and Diagnostic Challenges

Adrenal gland cancer often does not cause noticeable symptoms in the early stages, and when symptoms do appear, they are often vague and nonspecific, such as abdominal pain, fatigue, or weight loss. This makes early detection challenging. In many cases, adrenal cancer is diagnosed incidentally during imaging studies for unrelated conditions.

Medical imaging such as CT scans, MRI, and adrenal ultrasounds, along with hormonal tests, are crucial for diagnosing adrenal tumors and determining if they are malignant. Blood tests that measure hormone levels, such as cortisol, aldosterone, and catecholamines, can help identify functional tumors.

Adrenal gland cancer presents a wide array of symptoms that vary depending on the tumor’s size, hormone secretion, and whether it has metastasized. Hormonal imbalances, particularly the overproduction of cortisol, aldosterone, catecholamines, and androgens, can cause a range of symptoms that significantly impact a patient’s quality of life. Tumor size and local effects can lead to pain, palpable masses, and discomfort. In advanced stages, metastasis can lead to organ-specific symptoms. Early detection is key, but due to the nonspecific nature of symptoms, adrenal cancer may often be diagnosed at a later stage. Understanding these symptoms and their implications is vital for individuals at risk and can aid in timely intervention, improving patient outcomes.