Medical history and physical exam

The first step is to take your complete medical history to check for any symptoms. Your doctor will want to know if anyone in your family has had adrenal cancer. Your doctor will also ask you about your menstrual or sexual function and about any other symptoms that you may be having. A physical exam will provide other information about signs of adrenal gland cancer and other health problems. Your abdomen will be thoroughly examined by your doctor for evidence of a tumor (or mass).

Imaging tests will also be done to look for a mass in the adrenal gland. If a mass is found, a biopsy sample may be taken and looked at under the microscope. Your blood and urine will be tested to look for high levels of the hormones produced by some adrenal cortical adenomas and carcinomas. If a cancer is found, more tests will be done to determine its stage (how far the cancer has spread).

Signs and symptoms of adrenal cortex cancers

In about half of people with adrenal cortex cancer, symptoms are caused by the hormones made by the tumor. In the other half, symptoms occur because the tumor has grown so large that it presses on nearby organs. If you or your child has any of the signs or symptoms described in this section, discuss them with your doctor without delay. These symptoms may be caused by an adrenal cortical tumor or by something else. Getting the proper medical tests is the only way to find out. The sooner you get a correct diagnosis, the sooner you can start treatment and the more effective your treatment will be.

Symptoms caused by androgen or estrogen production

In children, the symptoms are most often caused by the androgens (male-type hormones) that the tumor might secrete. The most common symptoms are excessive growth of facial and body hair (such as in the pubic and underarm area). The male hormones may also cause enlargement of the penis in boys or the clitoris in girls. If the tumor secretes estrogens (female-type hormones), it can cause girls to start puberty early. This can cause the breasts to develop and menstrual periods to start. In boys, estrogen-producing tumors may cause breast enlargement.

In adults, the symptoms from high levels of sex hormones are less noticeable because they have already gone through puberty and have breasts and adult patterns of body hair. Women with estrogen-producing tumors and men with androgen-producing tumors usually do not have any symptoms unless the tumor is large enough to press on nearby organs. Symptoms are more easy to notice if the tumor is making the hormone that is not usually present. For example, men with tumors that make estrogen (female hormone) may notice breast enlargement with tenderness. They may also have sexual problems such as erectile dysfunction (impotence) and loss of sex drive. Women with tumors that make androgens (male hormones) may notice excessive facial and body hair growth, receding hairline, irregular menstrual periods, and deepening of their voice.

Symptoms caused by cortisol production

Excessive levels of cortisol causes a problem known Cushing syndrome. Although some people have all of these symptoms, many people with high cortisol levels have only 1 or 2 symptoms. These signs and symptoms include:

• weight gain, usually greatest around the chest and abdomen
• fat deposits behind the neck and shoulders
• purple stretch marks on the abdomen.
• excessive hair growth on the face, chest, and back in women
• menstrual irregularities
• weakness in the legs
• easy bruising
• depression and/or moodiness
• weakened bones (osteoporosis), which can lead to fractures
• high blood sugar, often leading to diabetes
• high blood pressure

Cushing syndrome may be caused by an adrenal cancer or an adrenal adenoma that produces high levels of cortisol and/or related hormones. Benign pituitary gland tumors and several types of cancers, such as lung cancer, can produce high levels of another hormone called adrenal corticotrophic hormone (ACTH). ACTH in turn causes normal adrenal gland tissue to produce more cortisol.

Some people with immune system problems or some cancers, such as lymphomas, are treated with drugs chemically related to cortisol. Because there are so many causes of high cortisol levels that can lead to Cushing syndrome, doctors do a number of blood tests, urine tests, and imaging tests to find out whether the patient has an adrenal cortical tumor or some other cause of Cushing syndrome.

Symptoms caused by aldosterone production:

The main signs and symptoms caused by aldosterone-producing adrenal tumors are high blood pressure, weakness, muscle cramps, excessive thirst, and excessive urination. Adrenal adenomas often produce this hormone, but adrenal cancers rarely do so.

Symptoms caused by a large adrenal cancer pressing on nearby organs:

As an adrenal cortical carcinoma grows, it presses on nearby organs and tissues. This may cause pain near the tumor, a feeling of fullness in the abdomen, or trouble eating because of a feeling of filling up easily.