Adrenal gland tumours
Which adrenal cells give rise to which tumours: common, usually silent cortical adenomas, adenomas that secrete aldosterone or cortisol, rare invasive adrenocortical carcinoma, and catecholamine-secreting phaeochromocytoma.
By the end, you can
- Relate the three zones of the adrenal cortex and the medulla to their hormones and to the tumours that arise from each.
- Explain how an autonomous cortical adenoma causes primary aldosteronism or ACTH-independent Cushing’s syndrome, and why most adenomas are silent.
- Distinguish adrenocortical adenoma from carcinoma by size, gross and microscopic features, invasion and hormone pattern.
- Explain how catecholamine release from a phaeochromocytoma causes paroxysmal hypertension, headache, sweating and palpitations, and why metanephrines rise.
- Recognise the classic appearances, the incidentaloma work-up and the hormone tests of adrenal tumours, and explain how adrenalectomy, receptor blockers, steroid synthesis inhibitors and mitotane act, including why alpha blockade comes before beta blockade.
What it is
Adrenal tumours arise from the cortex (adrenocortical adenoma, common and benign; adrenocortical carcinoma, rare and aggressive) or the medulla (phaeochromocytoma from chromaffin cells; neuroblastoma in young children). They cause disease by hormone excess (aldosterone, cortisol, androgens or catecholamines) or, when large or malignant, by mass and spread. The adrenal is also a common site of metastases from other cancers.
5 types to tell apart
- Adrenocortical adenoma
- Benign, usually small, yellow and lipid-rich. Most are non-functioning; some secrete aldosterone (Conn syndrome) or cortisol.
- Adrenocortical carcinoma
- Rare, usually large, necrotic and invasive; often secretes several steroids at once and spreads to the vena cava, liver and lungs.
- Phaeochromocytoma
- A catecholamine-secreting tumour of medullary chromaffin cells, often inherited; its counterpart outside the adrenal is a paraganglioma.
- Neuroblastoma
- An embryonal tumour of immature sympathetic (neural crest) cells, most often in the adrenal medulla of young children.
- Metastases
- Spread from cancers elsewhere, especially lung, breast and melanoma; often in both glands.
US spelling: tumours → tumors, adrenaline → epinephrine, noradrenaline → norepinephrine.
Normal function
Two endocrine glands in one
Each sits on the upper pole of a . It is two glands in one: an outer cortex, derived from mesoderm, which makes steroid hormones from cholesterol, and an inner medulla, derived from neural crest, which makes catecholamines.
The cortex has three zones. The thin outer zona glomerulosa makes aldosterone, driven by angiotensin II and plasma potassium. The broad middle zona fasciculata, whose cells are packed with lipid droplets, makes cortisol under the control of ACTH. The inner zona reticularis makes weak androgens such as DHEA.
The medulla’s chromaffin cells are modified sympathetic neurones without axons. Stimulated by preganglionic sympathetic nerves, they release adrenaline (mostly) and noradrenaline into the blood. Cortisol-rich blood flowing inwards from the cortex induces the enzyme that converts noradrenaline to adrenaline, which is why the adrenal medulla is the main source of adrenaline.
| Feature | Main hormone and its control | Tumours that arise |
|---|---|---|
| Zona glomerulosa (outer cortex) | Aldosterone; angiotensin II and potassium | Aldosterone-producing adenoma (Conn syndrome) |
| Zona fasciculata (middle cortex) | Cortisol; ACTH | Cortisol-secreting adenoma; most non-functioning adenomas resemble these cells |
| Zona reticularis (inner cortex) | Weak androgens (DHEA); ACTH | Androgen excess, mainly from carcinoma |
| Medulla (chromaffin cells) | Adrenaline and noradrenaline; sympathetic nerves | Phaeochromocytoma; neuroblastoma in young children |
| Whole gland | Rich blood supply | Adrenocortical carcinoma; metastases from lung, breast and melanoma |
Simplified; a carcinoma can secrete hormones of several zones at once.
Underlying change · Step 1 of 5
Cortical adenomas: common and usually silent
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 5
Autonomous aldosterone and cortisol
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 5
Adrenocortical carcinoma: large, invasive, often secreting
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 4 of 5
Phaeochromocytoma: a tumour of chromaffin cells
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 5 of 5
Catecholamine surges and other effects
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .