Being told you have a lump on your adrenal gland can be worrying. The reassuring news is that most adrenal tumours are benign. This guide explains what the glands do, the main tumour types, how they are assessed, when surgery is considered, recovery, and which symptoms need urgent attention.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed: · Last updated:
What do the adrenal glands do?
You have two adrenal glands, one sitting on top of each kidney. According to the Endocrine Society of Australia’s Hormones Australia fact sheet, they make several important hormones:
- Aldosterone, which helps control blood pressure through salt and water balance.
- Cortisol, the body’s stress hormone, which affects how sugar and fat are used.
- Adrenaline and noradrenaline (catecholamines), which drive the “fight or flight” response and affect heart rate and blood pressure.
What is an adrenal tumour or incidentaloma?
An adrenal tumour is a growth (mass) in an adrenal gland. When it is found by chance on a scan done for another reason, it is called an adrenal incidentaloma. According to the European Society of Endocrinology (ESE) patient leaflet, about 2% of adults have one, rising to 10% in older people, and over 90% are benign. The Hormones Australia fact sheet adds that fewer than a third produce excess hormones.
Types of adrenal tumour
| Type | Hormone involved | Possible signs | Usual approach |
|---|---|---|---|
| Non-functioning adenoma | None in excess | Usually none; found on a scan | Often no treatment if CT looks benign |
| Cortisol-producing tumour (Cushing’s syndrome) | Cortisol | Rounded face, central weight gain, bruising, high blood pressure | Surgery is usually considered |
| Aldosterone-producing tumour (Conn’s syndrome / primary hyperaldosteronism) | Aldosterone | Hard-to-control blood pressure, low potassium | Surgery or medicines, after specialist tests |
| Phaeochromocytoma | Adrenaline and noradrenaline | Episodes of headache, pounding heartbeat, sweating, high blood pressure | Surgery after careful preparation with medicines |
| Adrenal cancer (adrenocortical carcinoma) | Often cortisol or other hormones | Hormone symptoms, a large mass, sometimes pain | Surgery, with specialist cancer care |
The ESE leaflet also describes mild autonomous cortisol secretion, where a tumour makes a little extra cortisol without the typical features of Cushing’s syndrome. It can contribute to high blood pressure, type 2 diabetes or fragile bones. MedlinePlus describes adrenal cancer as rare.
Symptoms to be aware of
Many adrenal tumours cause no symptoms. MedlinePlus lists attacks of headache, palpitations, sweating and high blood pressure for phaeochromocytoma; purple stretch marks, easy bruising and muscle weakness for cortisol excess; and tiredness and muscle weakness for aldosterone excess. A large tumour may cause abdominal or back pain.
How adrenal tumours are diagnosed
The assessment, as described by the ESE and Hormones Australia, usually has two parts:
- Hormone tests. Blood, urine and sometimes saliva tests check for excess cortisol (for example an overnight dexamethasone suppression test), adrenaline-related substances (metanephrines), and, in people with high blood pressure or low potassium, aldosterone and renin. Some medicines can affect results, so your doctor may adjust them first.
- Imaging. A CT scan without contrast is the first-line test to judge whether the mass looks benign. According to Hormones Australia, a tumour under 4 cm is less likely to be cancerous, and a low density on CT (under 10 Hounsfield units) is highly reassuring. MRI, contrast CT or PET is used in some cases.
The ESE leaflet notes that a biopsy is rarely useful. For aldosterone-producing tumours, MedlinePlus explains that a test sampling blood from the adrenal veins may be needed to show which gland is responsible. Sometimes a mass is first seen on an ultrasound of the abdomen; see our guide to urology ultrasound.
Surgery or monitoring?
According to the ESE leaflet, removal of the affected adrenal gland (adrenalectomy) is usually preferred when the tumour produces excess hormones or looks suspicious for cancer, taking into account your age and general health. If the tumour is benign on CT and does not make excess hormones, no further follow-up is usually needed. In unclear cases, repeat scans and tests may be advised, and complex cases are discussed by a multidisciplinary team.
Most adrenalectomies are keyhole (laparoscopic) operations, sometimes robot-assisted; open surgery is occasionally needed. A Kingston Hospital NHS leaflet states the operation usually takes about 2 to 3 hours under general anaesthetic. For phaeochromocytoma, MedlinePlus explains that medicines are given beforehand to stabilise blood pressure and pulse. Related reading: our nephrectomy guide and kidney cancer guide.
Recovery and working with endocrinologists
The Kingston Hospital NHS leaflet says most patients go home within 1 to 3 days, tiredness can last up to 2 months, and heavy lifting and strenuous exercise should be avoided for 3 to 4 weeks. Listed risks include discomfort, bleeding, infection, blood clots, injury to nearby organs and, rarely, too little steroid hormone. After removal of a cortisol-producing tumour, MedlinePlus notes that steroid replacement is usually needed for 3 to 12 months while the other gland recovers; this is planned and monitored by your doctors.
Care is usually shared: an endocrinologist interprets hormone tests, prepares you for surgery and follows you up, while the surgeon (often a urologist or endocrine surgeon) assesses whether an operation is needed. According to Your Hormones (Society for Endocrinology), people treated for phaeochromocytoma need long-term follow-up, and genetic testing may be offered because some cases run in families.
When to seek urgent medical help
Seek emergency care if you have:
- A sudden, severe headache with a pounding heartbeat, sweating or chest pain, especially if you know you have an adrenal tumour.
- After adrenal surgery: fever or sweating, repeated vomiting, or feeling extremely unwell, as the Kingston NHS leaflet advises.
- Severe weakness, dizziness or fainting, particularly if you take steroid replacement.
See a doctor soon if a scan has shown an adrenal mass or your blood pressure is hard to control. Tests and treatment are decided by your doctor.
Frequently asked questions
Is an adrenal tumour usually cancer?
No. According to the European Society of Endocrinology patient leaflet, over 90% of adrenal incidentalomas are benign, and adrenal cancer is rare. A CT scan and hormone tests help doctors decide whether a tumour looks benign and whether further tests or treatment are needed.
Do all adrenal tumours need to be removed?
No. Surgery is usually considered when a tumour makes excess hormones or looks suspicious on imaging. A benign-looking tumour that does not produce extra hormones often needs no treatment, or only follow-up scans and tests, as your doctor advises based on your results and general health.
What tests will I need?
Most people have blood and urine tests, and sometimes saliva tests, to check cortisol, adrenaline-related substances and, if blood pressure is high, aldosterone and renin. A CT scan without contrast helps judge whether the mass looks benign. MRI or other scans are used in some cases.
How is adrenal surgery done?
Adrenal gland removal (adrenalectomy) is most often keyhole surgery, sometimes robot-assisted, through a few small cuts under general anaesthetic; an open operation is sometimes needed. For hormone-producing tumours, your endocrinologist prepares you beforehand to make the operation as safe as possible.
How long is recovery after adrenalectomy?
According to a Kingston Hospital NHS leaflet, most people go home within 1 to 3 days, should avoid heavy lifting and strenuous exercise for 3 to 4 weeks, and may feel tired for up to 2 months.
Can I live normally with one adrenal gland?
In most cases, yes. The remaining adrenal gland usually makes enough hormones. After some operations, especially for cortisol-producing tumours, temporary steroid replacement may be needed while the other gland recovers. Your doctors monitor this.
Sources
- European Society of Endocrinology – Adrenal incidentaloma: patient leaflet
- Hormones Australia (Endocrine Society of Australia) – Adrenal Incidentaloma fact sheet
- MedlinePlus – Cushing syndrome due to adrenal tumor
- MedlinePlus – Primary and secondary hyperaldosteronism
- MedlinePlus – Pheochromocytoma
- Your Hormones (Society for Endocrinology) – Phaeochromocytoma
- Kingston and Richmond NHS Foundation Trust – Adrenal gland removal with robot
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Prof. Samir Al-Samarrai and Dr. Amer Mousa assess urological conditions at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
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