August 01, 2019

Is a growth found on my adrenal gland cancerous?

Q: I was having an abdominal CT scan for another reason and a mass was found on the adrenal gland on top of one of my kidneys. My doctors say it's unlikely to be cancer but recommend keeping an eye on it. Shouldn't a biopsy be done?

A: Fortunately, if a mass is found in one or both of the hormone-releasing adrenal glands, it is usually not cancer and causes no other problems. However, an evaluation of the mass is typically necessary.

Adrenal masses are estimated to occur in 3% to 7% of older adults. About 95% of the time, they're not cancerous. However, a small number of these noncancerous adrenal masses can increase hormone levels and cause health problems such as high blood pressure, low potassium, diabetes and even increased risk of heart disease.

Distinguishing a potentially harmful mass from a harmless one can often be done with imaging, most commonly a CT scan targeted at assessing the mass. A cancerous mass will likely be larger with an irregular shape. A noncancerous mass will likely have a smoother, rounder shape and be smaller. Excess hormone production — if present — can be documented using certain blood or urine tests.

Although imaging can provide very good information, it can't make an absolute distinction between a cancerous and a noncancerous mass. Biopsy — which is often a go-to diagnostic test for other types of tumors — is ineffective at making this distinction with most adrenal masses, and can be harmful. However, a biopsy may be helpful in people with a known cancer that may have spread to the adrenal gland.

In masses that are larger, have cancer-like characteristics or are having a harmful impact on hormone levels, surgical removal of the mass is likely to be discussed or recommended. Fortunately, the majority...