Understanding Adrenal Tumours: Diagnosis and Treatment Insights

Adrenal tumours, particularly those affecting hormone production, can significantly impact an individual's health. Diagnosing these tumours typically involves evaluating serum levels of several hormones, including dehydroepiandrosterone (DHEA), androstenedione, testosterone, and estradiol, alongside glucocorticoid status. While some laboratories may measure only DHEA sulfate (DHEAS), increased levels of these hormones often indicate the presence of an adrenal or gonadal source, necessitating further imaging techniques such as CT or MRI.

When cortisol levels are found to be normal, but sex steroid levels are elevated, distinguishing between adrenal and gonadal sources becomes crucial. This often requires advanced imaging alongside potential catheterization for sampling adrenal and ovarian veins. Identifying the origin of the hormone excess is vital for determining the appropriate treatment strategy.

Surgical intervention is the primary treatment for adrenal tumours, particularly when they involve the removal of the affected adrenal gland. The timing of hormone measurements, such as aldosterone, is also essential; samples are ideally taken mid-morning after the patient has been seated for approximately 15 minutes. Positive screening for disorders like primary hyperaldosteronism is indicated by a high aldosterone-to-renin ratio, though interpretation can vary based on specific thresholds.

Endocrinologists often emphasize the interpretation of this ratio in conjunction with aldosterone levels, as a very low renin concentration can lead to misleadingly high ratios. A normal or low aldosterone-to-renin ratio typically indicates the absence of primary aldosterone excess. In cases where the ratio is elevated, additional tests are conducted to confirm the diagnosis, often involving an assessment of aldosterone suppression in response to intravenous saline or fludrocortisone.

Beyond hormone levels, it is also important to explore potential causes of hypokalaemia, which may result from conditions such as primary hyperaldosteronism, gastrointestinal losses, and diuretic use, among others. Several rare genetic conditions, like Gitelman syndrome and Liddle syndrome, can also contribute to this electrolyte imbalance.

While the most common malignant tumour of the adrenal cortex is metastatic, primary adrenal carcinoma remains a rare occurrence. Understanding the nuances of adrenal tumours is essential for effective diagnosis and treatment, highlighting the importance of specialized care in managing these complex conditions.