Adrenal Tumor Diagnosis

Diagnosing adrenal tumors can be complex because these tumors are diverse, may or may not produce hormones, and can be difficult to detect without specialized testing. An accurate diagnosis is important to determine the type of adrenal tumor and the best treatment approach.

If you have symptoms that could indicate an adrenal tumor — such as high blood pressure, fatigue, weight changes or hormone-related issues — your doctor will begin with a physical exam and a review of your medical history. You may be referred to an endocrinologist, a doctor who treats hormone-related diseases.

Specialized care and expertise

At UT MD Anderson, adrenal tumor diagnosis is guided by experts in endocrine oncology who use state-of-the-art diagnostic tools. These specialists are experienced in identifying both common and rare adrenal tumors, including functioning tumors that secrete hormones and non-functioning tumors that do not.

Common diagnostic tests for adrenal tumors

Your care team may recommend one or more of the following tests to confirm the presence of an adrenal tumor and determine its type, size, location and whether it is affecting hormone production.

Blood tests

These measure levels of adrenal hormones and related substances to evaluate whether the tumor is functioning:

• Cortisol: High levels may indicate Cushing’s syndrome.
• Aldosterone: Elevated levels can signal hyperaldosteronism, which is a condition where excess aldosterone causes high blood pressure and low potassium.
• Plasma metanephrines: High levels may indicate pheochromocytoma, which is a rare adrenal tumor that produces too many stress hormones.
• Dehydroepiandrosterone (DHEA): Elevated levels may occur in some adrenal cancers.
• ACTH (adrenocorticotropic hormone): This test helps assess how the adrenal and pituitary glands are interacting.
• Electrolytes: These include sodium and potassium, which can be affected by hormone imbalances.

Urine tests

• 24-hour urine collection is used to measure hormone levels over a full day, especially cortisol, aldosterone, or metanephrines.
• These tests help detect hormone overproduction not seen in a single blood sample.

Imaging tests

These scans provide detailed pictures of the adrenal glands and are used to detect whether a tumor is present, as well as determine its size, shape and whether it may have spread.

• CT scan: This test is commonly used to find adrenal tumors and assess their features.
• MRI scan: This scan provides detailed images and is especially useful for identifying tumors such as pheochromocytomas.
• PET scan: This imaging test may be used to look for cancer that has spread.
• MIBG scan: This nuclear medicine test helps detect pheochromocytomas and paragangliomas.

Adrenal vein sampling (AVS)

This specialized procedure involves drawing blood from the veins from each adrenal gland to compare hormone levels. AVS helps determine which gland is overproducing hormones and whether both glands are involved. It is typically done in centers with expertise in adrenal disorders.

Biopsy

A biopsy is a procedure where doctors remove a small sample of tissue or cells from the body to examine it more closely. It helps diagnose diseases, including cancer, by checking for abnormal cells.

Adrenal tumors are usually diagnosed with imaging and hormone testing, so biopsy is not often needed. In some cases, a biopsy may be used to determine whether a tumor has spread from another part of the body. Because certain adrenal tumors can release hormones if disturbed, biopsies are only done when they are safe and necessary. In many cases, the exact tumor type is confirmed after surgery.

Genetic testing and counseling

If you or a family member has a genetic condition linked to adrenal tumors, your doctor may recommend genetic testing. This can help assess your risk, guide monitoring and support early diagnosis.

Adrenal tumors can be challenging to detect because their symptoms often look like other more common conditions, such as high blood pressure, weight changes or fatigue. Because of their complexity, it’s important to work with a specialist, like an endocrinologist, who understands adrenal disorders. Early diagnosis and expert care can make a significant difference in outcomes, especially for rare cancers like adrenocortical carcinoma and pheochromocytoma.

There are no known ways to prevent adrenal tumors, but people with a family history of related genetic syndromes may benefit from regular screening and genetic counseling.

Learn more about adrenal tumors:

• Adrenal tumor overview
• Adrenal tumor symptoms
• Adrenal tumor treatment