Adrenal Adenoma

Adrenal adenoma is considered to be the most common adrenal mass in adults where it accounts for 50% of all adrenal tumors [1]. A majority of the patients with this condition do not present with any signs and symptoms and do not require any type of treatment [2].

What is Adrenal Adenoma?

An adrenal adenoma is a benign tumor that develops in the adrenal glands. The tumor usually develop in a single gland but there are times that both glands are affected. These glands are triangular in shape and are situated above each kidney. Figure 1 shows the location of the adrenal glands [2].

Figure 1- The Location of the Adrenal Glands

The adrenal glands are part of the body’s endocrine system because they produce hormones that affect some body functions such as metabolism and stress response. It has 2 distinct parts and each one produce a different type of hormone [3].

The adrenal cortex, which is the inner part of the gland, produces essential hormones such as cortisol and aldosterone. The inner part, the adrenal medulla, creates non-essential hormones such as adrenaline.

Classifications

An adenoma that is not able to produce any hormone is called a non-functioning adrenal adenoma. Most of the cases of adrenal adenoma fall under this type do not present any signs or symptoms and do not require any treatment. These type of tumor is usually discovered by chance when an individual is being scanned for a different condition [4].

An adrenal adenoma that is able to produce hormones is classified as a functioning adrenal adenoma. The hormones that they produce is oftentimes in excess and may cause signs and symptoms similar to Cushing’s syndrome and hyperaldosteronism [2, 4, 5].

ICD-10 Code

The 2016 ICD-10-CM diagnosis code used for adrenal adenoma is D35.00. This code is for any benign neoplasm of the adrenal gland.  The code can either D35.01 or D35.02 depending if the tumor is located in the right or left adrenal gland [6].
Causes

The exact cause of adrenal adenoma is currently unknown but the currently accepted theory point to mutations in certain genes. There are several factors that increases the likelihood of this condition to occur [2, 4, 5].

Individuals who are afflicted with conditions that cause high levels of steroid hormones especially if it is uncontrolled.

Those with inherited diseases such as multiple endocrine neoplasia type I, Carney complex and Beckwith-Wiedemann syndrome.

As an individual ages, the probability of developing an adrenal adenoma also increases in which around 6% of patients that are over 60 years old has this kind of tumor.

Signs and Symptoms

Around 95% of the cases of adrenal adenoma are non-functioning and therefore they do not present any signs and symptoms of adrenal adenoma. Adrenal insufficiency is very rare in non-functioning adrenal adenoma and only occurs if both adrenal glands are affected [1, 7]

As mentioned earlier, functional adrenal tumors are still able to produce adrenal hormones but these are almost always produced excessively. Because of this, the presenting signs and symptoms depends of the type of hormones it produce. Some of the conditions it can cause may include Cushing’s syndrome and primary aldosteronism [2].

Cushing’s syndrome is caused by high levels of the hormone cortisol in the body. The most common symptoms of this syndrome include: upper body obesity, high blood sugar, appearance of bluish-red stretch marks on the skin and increased growth of facial and body hair for women [2].

If the hormone aldosterone is produced in excess, the balance of sodium and potassium in the blood will be affected. The symptoms that may be present are: elevated blood pressure, muscle weakness, headache and intermittent paralysis [2].

There are very rare occasions wherein bleeding happens into the adrenal adenoma and this will may cause pain in the flank or back area [4].

Diagnostic Tests

Imaging, such as CT scan or MRI, plays a big role in diagnosing adrenal tumors because it is through this way where most tumors are found. Every tumor that are discovered this way should undergo further tests such as blood hormone levels and biopsy are required to confirm the diagnosis. It is essential to identify whether the tumor is functional or non-functional before starting any course of treatment [4, 7].

Treatment

The treatment is different for nonfunctional and functional adrenal adenoma. Nonfunctional adrenal tumors do not usually require treatment as long as it doesn’t enlarge or show any sign of bleeding or degeneration. It is advisable for the individual with a nonfunctional mass to have a CT scan and MRI every 6 to 24 months to detect any changes in the size of the adrenal tumor. Blood hormone level tests may also be ordered to see if the tumor has started producing hormones.  [2, 4, 7, 8].

The treatment of choice for a functional adrenal tumor is adrenalectomy or the removal of the affected adrenal gland. Once the tumor has been removed, other symptoms caused by the condition will also resolve as well. But this option may not be viable for everyone because of the risks associated with the procedure and the anesthetic to be used. If the patient will not be able to tolerate the procedure, he will be given medications that will inhibit the action or lower the amount of the excess hormone in the blood [2, 4, 7, 8].
References

1. Grossman, A. B. (2014, May). Nonfunctional Adrenal Masses. Retrieved from Merck Manual: http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/adrenal-disorders/nonfunctional-adrenal-masses
2. Genetic and Rare Disease Information Center. (2014, November 24). Adenoma of the Adrenal Gland. Retrieved from Genetic and Rare Disease Information Center: https://rarediseases.info.nih.gov/gard/5745/adenoma-of-the-adrenal-gland/resources/1
3. Sargis, R. (2015, April 8). Overview of the Adrenal Gland. Retrieved from Endocrine Web: http://www.endocrineweb.com/endocrinology/overview-adrenal-glands
4. Chew, S. (2011, January 9). Adrenal adenomas. Retrieved from Netdoctor: http://www.netdoctor.co.uk/conditions/liver-kidney-and-urinary-system/a3029/adrenal-adenomas/
5. UCLA Endocrine Surgery. (n.d.). Adrenocortical Carcinoma. Retrieved from UCLA Endocrine Surgery: http://endocrinesurgery.ucla.edu/patient_education_adrenocortical_carcinoma.html
6. ICD10Data.com. (2015). Benign neoplasm of unspecified adrenal gland. Retrieved from ICD10Data: http://www.icd10data.com/ICD10CM/Codes/C00-D49/D10-D36/D35-/D35.00
7. Knipe, H., & Jones, J. (n.d.). Adrenal Adenoma. Retrieved from Radiopaedia: http://radiopaedia.org/articles/adrenal-adenoma
   www.cancer.org. (2015, February 25). Adrenal Cancer. Retrieved from www.cancer.org: http://www.cancer.org/cancer/adrenalcorticalcancer/detailedguide/adrenal-cortical-cancer-what-is-adrenal-cortical-cancer

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