Adrenal nodules are found in approximately 5-8% of all patients. The vast majority are benign (non-cancerous) and do not produce excess amounts of hormone. Most adrenal nodules do not cause any symptoms and are found only when imaging studies (CT scans, MRIs) are obtained to evaluate symptoms related to another problem. When a patient is found to have an adrenal nodule, a systematic approach should be followed to further evaluate the nodule. Evaluation of an adrenal abnormality found on imaging is done to ensure two things: 1) the nodule has benign imaging characteristics (make sure the nodule doesn't look like an adrenal cancer), and 2) ensure no evidence of hormone excess (make sure the nodule is producing too much of the hormones it normally produces).
An appropriate evaluation of a newly found adrenal nodule includes obtaining a CT scan or MRI done specifically to look at the adrenal glands. At University of Michigan, our team prefers to investigate adrenal abnormalities using CT first, and MRI if a different type of study is needed. Patients also have blood drawn and submit urine samples (drawn over 24 hours) to test for excess amounts of adrenal hormones. Other laboratory studies may be obtained depending on individual patient findings. If patients are found to have a benign appearing nodule by imaging and no evidence of excess hormone production, patients are scheduled for a follow-up CT scan in 6 months. If no changes in imaging characteristics are noted on subsequent scans, continued care can range from no further follow-up (nodule is considered benign and does not need to be followed) to imaging and biochemical/laboratory testing for five years.
If an adrenal nodule does not meet imaging criteria that is considered benign, surgery is recommended.
Biopsy of the adrenal gland is not favored by specialists, except in highly specific instances. Biopsy may be appropriate if there is significant concern that an adrenal abnormality is the result of metastatic disease from another source, when no other site of metastatic disease can be accessed for a biopsy. Biopsy of a pheochromocytoma [adrenal nodule producing adrenaline (epinephrine, norepinephrine, or dopamine)] is extremely dangerous and should not be done, as this can lead to extreme elevations in blood pressure and cause a stroke or heart attack. Biopsy of an adrenal mass not meeting imaging criteria for a benign process leads to recommendation for surgery regardless, and biopsy is not indicated. Puncture of an adrenal cancer by a needle or other instrument can potentially lead to increased recurrence at the site of the tumor after removal of the gland and decrease the chance for cure. It is extremely difficult for pathologists to differentiate a benign adrenal tumor from a malignant adrenal tumor from tissue obtained by a needle biopsy. Seek a second opinion if someone has recommended you have your adrenal nodule/mass biopsied.
If laboratory studies/blood-work show evidence of excess hormone production, further evaluation is pursued to determine what hormone is being produced and which gland is producing the excess hormone as not all excess hormone production comes from the nodule seen on imaging. Sometimes, the nodule is not producing excess hormone, but the entire gland (or both glands) may be responsible for producing too much of a particular hormone.
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To see an endocrine surgeon about your adrenal disorder, call our clinic at 734-936-5830.