7 Warning Signs and Symptoms of Adrenal Cancer You Should Know

Adrenal cancer, also known as adrenal carcinoma or adrenocortical carcinoma, is a rare but serious condition that develops in the adrenal glands. These small, triangular-shaped glands sit on top of each kidney and produce essential hormones that regulate metabolism, blood pressure, immune system, and stress response. When cancer develops in these glands, it can cause a wide range of symptoms due to excessive hormone production or the physical presence of a tumor mass.

Understanding the warning signs of adrenal gland cancer is crucial for early detection and timely medical intervention. While adrenal cancer is uncommon, affecting approximately 1-2 people per million annually, recognizing its symptoms can make a significant difference in treatment outcomes. This article explores the most common symptoms associated with adrenal cancer to help you identify potential warning signs.

1. Unexplained Weight Gain or Loss

One of the most noticeable symptoms of adrenal cancer is sudden, unexplained changes in body weight. This occurs because adrenal tumors often produce excessive amounts of hormones that directly affect metabolism and body composition.

Weight gain typically occurs when the tumor produces too much cortisol, leading to Cushing’s syndrome. This weight gain has distinctive characteristics:

• Fat accumulation in the face (moon face), upper back (buffalo hump), and abdomen
• Thin arms and legs despite central weight gain
• Rapid weight gain over weeks or months without dietary changes

Weight loss can also occur in some cases, particularly when the cancer is advanced or when the tumor affects appetite and metabolism. This unintentional weight loss may be accompanied by muscle wasting and general weakness, making it a concerning symptom that warrants immediate medical evaluation.

2. Abdominal or Back Pain

Pain in the abdomen or back is a common symptom of adrenal gland cancer, particularly as the tumor grows larger. The adrenal glands are located in the upper abdomen near the back, so tumors in this area can cause discomfort in multiple regions.

Characteristics of adrenal cancer-related pain include:

• Dull, persistent ache in the upper abdomen or flank area
• Pain that may worsen over time as the tumor enlarges
• Discomfort that doesn’t improve with typical pain relievers
• Feeling of fullness or pressure in the abdomen

The pain occurs because the growing tumor can press against surrounding organs, nerves, and tissues. In some cases, if the tumor becomes very large, it may create a palpable mass that can be felt during physical examination. Any persistent abdominal or back pain without an obvious cause should be evaluated by a healthcare professional.

3. High Blood Pressure (Hypertension)

Elevated blood pressure is a significant symptom of adrenal cancer, especially when the tumor produces excessive amounts of aldosterone or catecholamines (adrenaline and noradrenaline). This type of hypertension can be particularly severe and difficult to control with standard blood pressure medications.

Features of adrenal cancer-related hypertension include:

• Sudden onset of high blood pressure in previously healthy individuals
• Hypertension that develops before age 30 or after age 50
• Blood pressure that doesn’t respond well to multiple medications
• Episodes of extremely high blood pressure with headaches, sweating, and rapid heartbeat

When adrenal tumors produce excess catecholamines (pheochromocytoma features), patients may experience sudden spikes in blood pressure accompanied by palpitations, anxiety, and pallor. These episodes can be triggered by physical activity, stress, or certain foods. Persistent or difficult-to-control hypertension, especially in younger individuals, should prompt investigation for secondary causes including adrenal tumors.

4. Changes in Physical Appearance

Adrenal carcinoma can cause distinctive physical changes due to hormonal imbalances. These alterations in appearance can be distressing and often develop gradually over months.

In cases of excess cortisol production (Cushing’s syndrome):

• Round, red face (moon facies)
• Increased facial hair in women (hirsutism)
• Purple or pink stretch marks (striae) on the abdomen, thighs, or arms
• Thinning skin that bruises easily
• Acne or skin infections
• Fat deposit between the shoulders (buffalo hump)

In cases of excess androgen production:

• Excessive hair growth on face and body in women
• Deepening of voice in women
• Male pattern baldness in women
• Irregular or absent menstrual periods
• Early puberty in children

These physical changes occur because the tumor produces excessive amounts of steroid hormones. The specific appearance changes depend on which hormones are overproduced. Any unexplained physical changes, especially when multiple symptoms occur together, should be evaluated by a medical professional.

5. Muscle Weakness and Fatigue

Persistent muscle weakness and overwhelming fatigue are common symptoms of adrenal cancer. These symptoms can significantly impact daily activities and quality of life.

The muscle weakness associated with adrenal cancer typically presents as:

• Generalized weakness affecting both arms and legs
• Difficulty climbing stairs or rising from a seated position
• Reduced exercise tolerance and endurance
• Muscle wasting, particularly in the arms and legs

This weakness occurs due to several mechanisms. Excess cortisol can break down muscle protein, leading to muscle wasting. Additionally, hormonal imbalances can cause electrolyte disturbances, particularly low potassium levels (hypokalemia), which directly affects muscle function.

Fatigue in adrenal cancer is often profound and doesn’t improve with rest. Patients describe feeling exhausted even after adequate sleep. This fatigue can result from the cancer itself, hormonal imbalances, or the metabolic stress that tumors place on the body. When muscle weakness and fatigue persist for weeks without explanation, medical evaluation is essential.

6. Hormonal Imbalances and Related Symptoms

Since the adrenal glands produce multiple hormones, adrenal cancer often causes a variety of hormonal symptoms. These symptoms vary depending on which hormones are produced in excess by the tumor.

Symptoms related to excess cortisol:

• Increased thirst and urination (similar to diabetes)
• High blood sugar levels
• Mood changes including depression, anxiety, or irritability
• Difficulty concentrating or memory problems
• Insomnia or disrupted sleep patterns

Symptoms related to excess aldosterone:

• Frequent urination
• Excessive thirst
• Muscle cramps or spasms
• Numbness or tingling
• Weakness or paralysis in severe cases

Symptoms related to excess sex hormones (androgens or estrogens):

• In women: irregular periods, excessive hair growth, acne, voice deepening
• In men: breast enlargement (gynecomastia), decreased libido, erectile dysfunction
• In children: early or inappropriate puberty, rapid growth, genital changes

The combination and severity of hormonal symptoms provide important clues about the type and activity of the adrenal tumor. Hormone testing is typically required to confirm which hormones are elevated and guide further evaluation.

7. Abdominal Fullness and Palpable Mass

As adrenal cancer tumors grow, they can create a sensation of fullness in the abdomen or even become large enough to feel as a mass. This symptom typically indicates a more advanced tumor, as adrenal cancers can sometimes grow quite large before being detected.

Characteristics of this symptom include:

• Feeling of fullness or bloating in the upper abdomen
• Early satiety (feeling full after eating small amounts)
• Visible abdominal swelling or asymmetry
• A firm mass that can be felt in the upper abdomen or flank
• Discomfort or pressure sensation when lying down

Large adrenal tumors can compress nearby organs including the stomach, intestines, or kidneys, causing additional symptoms such as nausea, digestive issues, or changes in urination. The tumor may also press on blood vessels, potentially causing swelling in the legs or other circulation problems.

While smaller adrenal tumors are often discovered incidentally during imaging for other conditions, larger tumors that cause palpable masses typically indicate more advanced disease. Any unexplained abdominal mass or persistent fullness should be promptly evaluated with imaging studies and medical examination.

Main Causes of Adrenal Cancer

The exact causes of adrenal cancer remain largely unknown, but research has identified several risk factors and conditions associated with increased likelihood of developing this rare disease.

Genetic Syndromes: Certain inherited genetic conditions significantly increase the risk of adrenal cancer:

• Li-Fraumeni syndrome: A hereditary condition caused by mutations in the TP53 gene, increasing risk of multiple cancers including adrenal carcinoma
• Beckwith-Wiedemann syndrome: A growth disorder that increases cancer risk, particularly in children
• Multiple Endocrine Neoplasia (MEN1): A genetic disorder affecting hormone-producing glands
• Lynch syndrome: Also known as hereditary non-polyposis colorectal cancer, which can increase adrenal cancer risk

Genetic Mutations: Mutations in specific genes such as TP53, IGF2, and others involved in cell growth regulation have been associated with adrenal cancer development, even without inherited syndromes.

Age and Gender: Adrenal cancer shows two peak incidence periods – in children under 5 years old and in adults during their 40s and 50s. Women are slightly more likely to develop adrenal cancer than men.

Pre-existing Adrenal Conditions: While most adrenal tumors are benign, some evidence suggests that pre-existing adrenal adenomas (benign tumors) may rarely transform into cancer, though this is controversial and uncommon.

Environmental Factors: Unlike many other cancers, clear environmental or lifestyle risk factors for adrenal cancer have not been definitively established. Smoking, diet, and exposure to specific chemicals have not been consistently linked to adrenal cancer risk.

It’s important to note that most people with these risk factors will never develop adrenal cancer, and many people who develop adrenal cancer have no identifiable risk factors. The rarity of this cancer makes it difficult to study causative factors comprehensively.

Prevention of Adrenal Cancer

Unfortunately, there are no proven methods to prevent adrenal cancer, as the exact causes remain unclear and most cases occur without identifiable risk factors. However, certain strategies may help with early detection and risk management.

Genetic Counseling and Testing: Individuals with a family history of adrenal cancer or known genetic syndromes associated with increased cancer risk should consider:

• Genetic counseling to assess personal and family risk
• Genetic testing for known mutations when appropriate
• Regular screening and monitoring if genetic predisposition is confirmed
• Informing family members who may benefit from genetic evaluation

Regular Medical Check-ups: While routine screening for adrenal cancer in the general population is not recommended, regular health check-ups can help:

• Monitor blood pressure regularly, especially if difficult to control
• Investigate unexplained symptoms promptly
• Follow up on incidentally discovered adrenal masses
• Track any concerning physical or hormonal changes

Awareness of Symptoms: Being knowledgeable about adrenal cancer symptoms allows for earlier medical consultation when warning signs appear. Early detection, while not prevention, can significantly impact treatment outcomes.

Management of Genetic Syndromes: For individuals with genetic conditions that increase adrenal cancer risk, working closely with healthcare providers to develop appropriate surveillance protocols is essential.

Since prevention strategies are limited, the focus remains on awareness, early detection, and prompt medical evaluation of suspicious symptoms. Anyone with concerning symptoms or known risk factors should maintain regular communication with their healthcare provider.

Frequently Asked Questions

What is the most common symptom of adrenal cancer?

The most common symptoms are related to excess hormone production, particularly Cushing’s syndrome symptoms (weight gain, round face, high blood pressure) when the tumor produces too much cortisol. However, some adrenal cancers produce no hormones and may only cause symptoms from tumor growth, such as abdominal pain or a palpable mass.

How rare is adrenal cancer?

Adrenal cancer is very rare, occurring in approximately 1-2 people per million each year. It accounts for only about 0.2% of all cancers. Most adrenal tumors discovered are benign (non-cancerous) rather than malignant.

Can adrenal cancer be detected early?

Early detection can be challenging because symptoms often develop gradually or may be mistaken for other conditions. However, adrenal tumors are sometimes discovered incidentally during imaging tests (CT or MRI scans) performed for other reasons. When hormonal symptoms are present, blood and urine tests can detect abnormal hormone levels that prompt further investigation.

At what age does adrenal cancer typically occur?

Adrenal cancer has a bimodal age distribution, meaning it has two peak occurrence periods. The first peak occurs in children under 5 years old, and the second peak occurs in adults in their 40s and 50s. However, it can occur at any age.

Do all adrenal tumors produce hormones?

No, not all adrenal tumors produce hormones. Approximately 40-60% of adrenal cancers are “functioning” tumors that produce excess hormones and cause hormonal symptoms. The remaining “non-functioning” tumors don’t produce excess hormones and typically only cause symptoms related to the tumor’s size and location, such as pain or a palpable mass.

What should I do if I experience symptoms of adrenal cancer?

If you experience persistent symptoms such as unexplained weight changes, difficult-to-control high blood pressure, unusual physical changes, or abdominal pain, you should consult your healthcare provider promptly. They can perform appropriate examinations, order blood tests to check hormone levels, and arrange imaging studies if necessary. Early evaluation of concerning symptoms is important for accurate diagnosis and timely management.

Can stress cause adrenal cancer?

No, stress does not cause adrenal cancer. While the adrenal glands produce stress hormones like cortisol and adrenaline, normal stress does not lead to cancer development in these glands. The causes of adrenal cancer are primarily related to genetic factors and mutations, not lifestyle or stress levels.

Is adrenal cancer hereditary?

Most cases of adrenal cancer are not hereditary, occurring sporadically without family history. However, approximately 15% of cases are associated with inherited genetic syndromes such as Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome, or Lynch syndrome. If you have a family history of adrenal cancer or related genetic conditions, genetic counseling may be beneficial.

References:

• American Cancer Society – Adrenal Cancer
• Cancer.Net – Adrenal Gland Tumor
• Mayo Clinic – Adrenal Cancer
• NHS – Adrenal Gland Disorders
• National Organization for Rare Disorders – Adrenocortical Carcinoma