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An adrenal mass is often found unexpectedly, which can leave patients with more questions than answers. What does the finding actually mean? Does its size matter? Can it change over time?
These questions are especially important when the mass is identified as an adrenal adenoma. While many adrenal adenomas are benign, doctors still look closely at how the mass appears on imaging, whether it produces hormones, and whether it changes over time.
Understanding those details can help clarify when simple monitoring may be enough and when closer evaluation or treatment should be considered.
The adrenal glands are small glands located above the kidneys. They produce hormones involved in functions such as blood pressure regulation, metabolism, and the body's response to stress.
An adrenal adenoma is a benign tumor arising from the adrenal cortex. Many adrenal masses are discovered incidentally when a person undergoes imaging for an unrelated reason. These are commonly referred to as adrenal incidentalomas. Current European Society of Endocrinology guidelines note that most adrenal incidentalomas are nonfunctioning adrenocortical adenomas.
Adrenal adenomas can generally be described as:
This distinction matters because hormone production can influence treatment decisions even when the mass appears benign.
A benign adrenal adenoma is different from adrenocortical carcinoma, a rare cancer arising from the adrenal cortex. It is uncommon, with numbers being around 200 per year.
Rather than assuming an adrenal adenoma will eventually become cancerous, doctors focus on determining what the mass is when it is first discovered.
Dedicated adrenal imaging can provide valuable information. For example, current European guidelines recommend evaluating adrenal masses for characteristics such as whether they are homogeneous and lipid-rich. A homogeneous adrenal mass with specific benign characteristics on a noncontrast CT may not require additional imaging follow-up.
An adrenal mass that does not have clearly benign features may require additional imaging, hormone testing, follow-up, or discussion with specialists.
The key point is that having an adrenal mass does not automatically mean you have cancer. The characteristics of that particular mass determine how doctors approach it.
Another common concern is how fast do adrenal tumors grow? There is no single growth rate that applies to every adrenal tumor.
Benign adrenal tumors can remain stable or show slow growth over time. In contrast, malignant adrenal lesions are more likely to demonstrate rapid growth over a period of months. Growth alone, however, should not be used to diagnose an adrenal mass as benign or malignant.
For an adrenal mass that cannot be confidently classified as benign and is not removed, doctors may compare imaging studies over time. Current European guidelines suggest repeat noncontrast CT or MRI after 6 to 12 months for certain indeterminate adrenal masses. Significant growth during that period can lead to consideration of surgical treatment.
Previous scans can therefore be valuable. If an adrenal mass was visible on an older CT or MRI, comparing its size and appearance with current imaging can help doctors understand its behavior over time.
Doctors do not make treatment decisions based on one characteristic alone. Evaluation usually brings several factors together.
1. Size and Imaging Appearance: Size is one consideration, but imaging characteristics are equally important. Doctors evaluate features such as the mass's density, homogeneity, and overall appearance. Current guidelines identify some larger adrenal masses with heterogeneous features or other suspicious imaging characteristics as requiring multidisciplinary evaluation because of a greater concern for malignancy.
2. Changes Over Time: If the mass is indeterminate, comparing scans can show whether it is stable or changing. Significant or relatively rapid growth deserves further evaluation.
3. Hormone Production: An adrenal mass may produce excess cortisol, aldosterone, or catecholamines, depending on the tumor. Hormonal evaluation can therefore be an important part of determining how an adrenal mass should be managed.
4. Symptoms and Medical History: Doctors also consider symptoms, age, overall health, and previous medical history. A history of cancer elsewhere in the body, for example, changes how an adrenal mass may need to be evaluated.
Taken together, these factors provide a much clearer picture than tumor size alone.
Not every adrenal adenoma needs to be removed. In fact, guidelines recommend against surgery for an asymptomatic, nonfunctioning adrenal mass when imaging clearly shows benign characteristics.
Surgery may be considered when:
The decision should be individualized rather than based on a single number.
When surgery is appropriate, adrenalectomy involves removing the affected adrenal gland, Far North Surgery provides adrenal surgery.
Most adrenal adenomas are benign, and discovering one does not mean that it will become cancerous. What matters is establishing whether the mass has reassuring features, produces hormones, or shows characteristics that require closer evaluation.
If an adrenal mass has been discovered on your imaging, discuss its size, imaging characteristics, hormone testing, and any previous scans with your healthcare team.
Far North Surgery provides evaluation and surgical care for adrenal conditions in Anchorage, Alaska. If your adrenal tumor requires surgical assessment, schedule a consultation to discuss your diagnosis and whether adrenal surgery may be appropriate for you.
Yes, but size is only one part of the evaluation. Imaging appearance, hormone activity, growth, symptoms, age, and medical history can also influence management decisions.
Doctors use dedicated imaging characteristics, hormone testing, changes in size over time, symptoms, and medical history. Indeterminate or suspicious masses may require additional evaluation by a multidisciplinary team.
Surgery may be considered when a tumor produces clinically significant excess hormones or has imaging, growth, or other characteristics that raise concern. Clearly benign, nonfunctioning, asymptomatic adrenal masses generally do not require surgery.
A benign adrenal adenoma is different from adrenocortical carcinoma. Doctors generally evaluate an adrenal mass based on its imaging appearance, hormone production, size, and growth rather than assuming that a benign adenoma will become cancerous.
There is no single growth rate for adrenal adenomas. Many remain stable or grow slowly. If an adrenal mass has indeterminate features, doctors may recommend follow-up imaging to monitor for significant changes.
