Signs and Symptoms of Adrenal Cancers

In about half of people with adrenal cancer, symptoms are caused by the hormones made by the tumor. In the other half, symptoms occur because the tumor has grown so large that it presses on nearby organs. If you or your child has any of the signs or symptoms described here, discuss them with your doctor without delay. These symptoms may be caused by an adrenal tumor or by something else. Getting the proper medical tests is the only way to find out and to get the proper treatment, if needed.

Symptoms caused by androgen or estrogen production

In children, symptoms are most often caused by the androgens (male-type hormones) that the tumor secretes. The most common symptoms are excessive growth of facial and body hair (such as in the pubic and underarm areas). Male hormones may also enlarge the penis in boys or the clitoris in girls.

If the tumor secretes estrogens (female-type hormones), girls can start puberty early. This can cause breasts to develop and menstrual periods to start. Estrogen-producing tumors can also enlarge breasts in boys.

The symptoms from high levels of sex hormones are less noticeable in adults because they have already gone through puberty and have breasts and adult patterns of body hair. Women with estrogen-producing tumors and men with androgen-producing tumors usually do not have any symptoms from the hormones, so they might not have symptoms until the tumor is large enough to press on nearby organs.

Symptoms are easier to notice if the tumor is making the hormone usually found in the opposite sex. For example, men with tumors that make estrogen may notice their breasts becoming enlarged and tender. They may also have sexual problems such as erectile dysfunction (impotence) and loss of sex drive. Women with tumors that make androgens (male hormones) may notice excessive facial and body hair growth, a receding hairline, irregular menstrual periods, and deepening of their voice.

Symptoms caused by cortisol production

Excessive levels of cortisol causes a problem known as Cushing syndrome. Some people have all of these symptoms, but many people with high cortisol levels have only a few. Possible signs and symptoms include:

• Weight gain, usually greatest above the collar bone, in the cheek area (moon face), and around the abdomen
• Fat deposits behind the neck and shoulders (fatty hump or buffalo hump)
• Purple stretch marks on the abdomen
• Excessive hair growth on the face, chest, and back in women
• Menstrual irregularities
• Weakness and loss of muscle mass in the legs
• Easy bruising
• Depression and/or moodiness
• Weakened bones (osteoporosis), which can lead to fractures
• High blood sugar levels, often leading to diabetes
• High blood pressure

Cushing syndrome may be caused by an adrenal cancer or an adrenal adenoma that makes high levels of cortisol and/or related hormones, but it can also have other causes. For example, benign pituitary gland tumors can make high levels of another hormone called adrenocorticotropic hormone (ACTH). This is often called Cushing disease. The high levels of ACTH in turn cause normal adrenal gland tissue to make more cortisol. This results in the same symptoms as Cushing syndrome. Very rarely, other tumors  can make ACTH and cause the same symptoms.

Some people with immune system problems or some cancers, such as lymphomas, are treated with drugs chemically related to cortisol.

Because there are so many causes of high cortisol levels that can lead to Cushing syndrome, doctors do a number of tests to find out whether the patient has an adrenal cortical tumor or some other cause of Cushing syndrome.

Symptoms caused by aldosterone production

The main signs and symptoms caused by aldosterone-producing adrenal tumors are:

• High blood pressure
• Weakness
• Muscle cramps
• Low blood potassium levels

Adrenal adenomas often make aldosterone, but adrenal cancers rarely do.

Symptoms caused by a large adrenal cancer pressing on nearby organs

As an adrenal cancer grows, it presses on nearby organs and tissues. This may cause pain near the tumor, a feeling of fullness in the abdomen, or trouble eating because of a feeling of filling up easily.