Understanding Endocrine and Metabolic Conditions

Adrenal nodules are growths or masses that form on the adrenal glands—small glands located on top of each kidney. These glands produce vital hormones such as cortisol, aldosterone, adrenaline, and androgens that help regulate metabolism, blood pressure, immune function, and stress response. Adrenal nodules are often found incidentally during imaging tests (like CT or MRI scans) performed for unrelated reasons and are referred to as adrenal incidentalomas. While most adrenal nodules are benign and non-functioning (meaning they do not produce hormones), some can be hormonally active or, in rare cases, malignant.

Non-functioning adenomas (most common): Benign and do not secrete hormones.

Functioning adenomas: These produce excess hormones and may lead to conditions such as:

• Cushing’s syndrome (excess cortisol)
• Primary aldosteronism (excess aldosterone)
• Pheochromocytoma (excess catecholamines like adrenaline)

• Age: More common in individuals over age 50.
• Incidental discovery: Increasingly found due to more frequent imaging for other health issues.
• Genetic conditions: Rarely, adrenal tumors may be associated with hereditary syndromes like MEN (multiple endocrine neoplasia) or Li-Fraumeni syndrome.

If a nodule produces excess hormones, patients may experience:

• Weight gain, especially in the face and abdomen
• High blood pressure
• Muscle weakness
• Mood changes or anxiety
• Irregular periods or increased facial/body hair in women
• Headaches, sweating, palpitations (with pheochromocytoma)

Non-functioning nodules typically cause no symptoms.

Evaluation involves both hormonal testing and imaging:

• Blood and urine tests: Check for excess cortisol, aldosterone, and catecholamines.
• Imaging: CT or MRI scans assess size, shape, and characteristics of the nodule.
• Size criteria: Nodules <4 cm with benign imaging features are often monitored. Nodules >4 cm or with suspicious features may need surgical removal or biopsy.

• Non-functioning and benign-appearing nodules <4 cm: Often monitored with follow-up imaging and hormone testing over time.
• Functioning nodules or those >4 cm: Often require surgical removal.
• Malignant or suspicious features: Referred to oncology/endocrine surgery for further evaluation and treatment.

Comprehensive hormonal evaluation

Imaging review and interpretation

Referral to specialists (endocrine surgery, oncology) when needed

Patient education on signs to monitor and long-term follow-up planning