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Is it a tumor?

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Any abnormal growth of cells that forms a mass in the body is called a tumor. These can start to grow from any cell in the body and depending on the type of cell may either be benign or noncancerous, precancerous, or cancerous which are the malignant tumors.

Many benign tumors are called adenomas, from the Greek aden, meaning “gland” and –oma denoting the tumor or abnormal growth. Some tumors are visible to the eye if they are just under the skin like lipomas which are benign tumors made up of fatty tissue or in the front of the neck like a goiter which can be a thyroid adenoma.

But there are some tumors that are only found by accident when an imaging test is done to look at something else. Since the tumor is an unexpected finding and not related to why the test was done in the first place, it is called an incidental tumor or an “incidentaloma.”

One of the more common incidentalomas is the adrenal incidentaloma. There are two adrenal glands, one found on top of each kidney, thus they are sometimes called the suprarenal glands. The adrenals are endocrine organs that produce hormones such as cortisol, adrenaline and aldosterone that control many functions in the body.

An adrenal tumor is considered an adrenal incidentaloma when it measures more than 1 centimeter and is found only by chance when a CT scan and MRI is done to examine the abdominal area for another reason. About 1 to 10 percent of patients who get these tests done have an adrenal incidentaloma, and it becomes more common with age.

These adrenal tumors are usually benign noncancerous masses that cause no symptoms and don’t require treatment and are called non-functioning adrenal adenomas. But sometimes even benign adrenal tumors can secrete hormones and are called functioning adrenal adenomas. About 15 percent of adrenal incidentalomas can produce abnormal levels of hormones. But even with this abnormal secretion of hormones patients may not notice any symptoms if the hormone levels are not too high.

So when an adrenal incidentaloma is discovered, treatment will depend on whether the tumor is benign or malignant, or whether the tumor is functioning or non-functioning. Tumors more than 4 centimeters in size are generally removed surgically because they pose more of a cancer risk. A special CT scan or MRI is also done to look more closely at the appearance of the tumor to determine if it is more likely benign or cancerous.

Each adrenal gland contains two types of tissue: the cortex and the medulla. Benign adrenal tumors that develop in the cortex are called adrenal adenomas. Benign adrenal tumors that develop in the medulla are called pheochromocytomas (fee-o-kroe-moe-sy-TOE-muhs). The signs and symptoms may vary depending on the level and type of hormone that is being produced.

The most common hormone that can be over-secreted is cortisol from the cortex, a condition called Cushing’s syndrome. Patients with adrenal incidentalomas however may not make enough cortisol to produce the typical appearance of patients with Cushing’s syndrome such as the rounded face, a fatty hump between the shoulders, and large pink or reddish stretch marks on the skin. But they can have hypertension, type 2 diabetes and osteoporosis because of the excess cortisol.

Pheochromocytomas are tumors that make excess adrenaline hormones from the medulla of the adrenal gland. The hormones are not constantly being released by the medulla and so the signs and symptoms are usually episodic and consist of high blood pressure, rapid heart rate, headache, sweats, tremors and anxiety attacks.

Excess aldosterone from the cortex also causes elevated blood pressure and sometimes low potassium levels.

If an adrenal incidentaloma is found, your doctor will order blood and urine tests to determine if the tumor is making excess hormones. If it is found that the tumor is functioning, the treatment of may include surgery, medication to help control the hormone levels, or both.

Non-functioning tumors with a benign appearance should be re-examined with repeat imaging at six to 12 months after the initial discovery, with possible surgical removal if it enlarges by more than 1 centimeter in diameter. Get regular check-ups and inform your doctor if you develop any symptoms because early detection can help prevent the development of long-term complications.

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