The adrenal glands are small, triangular glands located above each kidney, but they play a major role in regulating blood pressure, metabolism and the body’s response to stress. Adrenal tumours are relatively uncommon, and many cause no symptoms. Yet some can quietly affect health by producing excessive amounts of hormones or may be discovered unexpectedly during scans performed for an unrelated problem. According to Dr Ashwin Mallya, Uro-Oncologist and Robotic Surgeon, Sir Ganga Ram Hospital, increasing use of abdominal imaging is leading to more adrenal incidentalomas – masses discovered accidentally during CT scans, MRI scans or other investigations. Also read: Thyroid Surgery Without a Neck Scar? Why More Young Patients Are Choosing ‘Scarless’ Options Why adrenal tumours can be difficult to detect? Some adrenal tumours do not produce hormones and may remain unnoticed for years. Others are hormone-secreting adrenal tumours, producing excess cortisol, aldosterone or catecholamines. Their symptoms can resemble common conditions such as anxiety, hypertension or diabetes, making the underlying problem easy to overlook. “One important example is pheochromocytoma, a tumour that produces excess catecholamines. Warning signs may include sudden episodes of high blood pressure, severe headaches, racing heartbeat, excessive sweating and a feeling of anxiety or panic,” said Dr. Mallya. When these symptoms repeatedly occur without a clear explanation, medical evaluation may be necessary. Resistant hypertension could be a warning sign Another adrenal condition is primary aldosteronism, sometimes known as Conn’s syndrome. It occurs when an adrenal tumour or other abnormality causes excessive production of aldosterone, a hormone involved in regulating blood pressure and potassium levels. A person whose blood pressure remains high despite multiple medications, particularly when accompanied by unexplained low potassium, may need evaluation for excess aldosterone. “These symptoms should not automatically be attributed to an adrenal tumour, but they can be important clues that warrant further investigation,” said Dr. Mallya. Some tumours are discovered by chance Adrenal masses are increasingly detected incidentally when patients undergo abdominal imaging for other reasons. An Indian study published in 2024 examined more than 1,600 abdominal CT scans at a tertiary-care centre and reported adrenal incidentalomas in 0.5 per cent of scans overall, rising to 0.9 per cent among patients over 40. The study also found that around one-quarter of identified incidentalomas had not been mentioned in the initial radiology report, highlighting the importance of careful assessment of the adrenal glands during abdominal imaging. When can adrenal tumours become dangerous? Size, appearance, growth pattern and hormone production all influence how an adrenal mass is evaluated. Large or malignant tumours can invade surrounding structures and may require more extensive surgery. Pheochromocytomas also require particular care. Because they can release large amounts of hormones that dramatically affect blood pressure, patients generally need careful medical preparation and stabilisation before surgery. For appropriately selected patients, smaller adrenal tumours can often be removed using laparoscopic or robotic adrenalectomy, potentially offering smaller incisions and faster recovery than traditional open surgery. Warning signs worth discussing with a doctor An adrenal tumour may produce no symptoms at all, but certain findings deserve medical attention, including: Difficult-to-control or resistant high blood pressure Unexplained low potassium levels Recurrent episodes of palpitations and sweating Sudden headaches associated with blood-pressure spikes Unexplained weight changes or metabolic abnormalities An adrenal mass discovered during an abdominal scan An adrenal tumour is not the most likely explanation for these symptoms in every patient. However, persistent or unexplained abnormalities should not simply be dismissed.

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