Adrenocortical carcinoma is a rare tumor afflicting only one or two persons per one million population. It usually occurs in adults, and the median age at diagnosis is 44 years. Although potentially curable at early stages, only 30% of these malignancies are confined to the adrenal gland at the time of diagnosis. Because these tumors tend to be found years after they began growing, they have the opportunity to invade nearby organs, spread to distant organs (metastasize) and cause numerous changes in the body because of the excess hormones they produce.
Characteristics of Adrenal Cortical Cancer
- Typically an aggressive cancer
- Most (~60%) are found because excess hormone production causes symptoms which prompt patients to seek medical attention
- Most (60-80%) actually secrete high amounts of one or more adrenal hormones
- Many will present with pain in the abdomen and flank (nearly all that don’t present with symptoms of hormone excess will seek medical attention because of pain)
- Spread to distant organs (metastasis) occurs most commonly to the abdominal cavity, lungs, liver, and bone
Adrenal Syndromes Caused by Excess Hormone Secretion
As noted in our example above, many patients will seek medical attention with some sort of bodily change which typically comes on quite slowly (usually over 1 to 3 years). When excess female hormones are produced in a female it can be hard to detect, except at extremes of age such as early puberty in a child, or the return of vaginal bleeding in a post-menopausal woman. The same is true for excess testosterone in a male. The opposite, however, will often make the presentation easier such as when a woman begins to develop male characteristics (deeper voice, excess body hair) or when a man begins to develop enlarged breasts. Some of these hormone overproduction problems have specific names and are listed below.
- hypercortisolism (Cushing’s syndrome) (excess cortisol produced)
- adrenogenital syndrome (excess sex steroids produced)
- virilization (acquisition of male traits in a female because of excess testosterone production)
- feminization (acquisition of female traits in a male because of excess estrogen production)
- precocious puberty (puberty occurring too early because of excess sex steroids produced)
- hyperaldosteronism (Conn’s syndrome) (excess aldosterone leading to hypertension and low potassium)