Dear Dr. Roach: My husband's recent CT scan of his stomach and digestive system with and without contrast revealed that he has nodules on both adrenal glands.
It was suggested that he undergo a blood test to determine if the nodules are producing hormones.
For the past 21 months, he has been experiencing high blood pressure, nausea, diarrhea, anxiety and abdominal pain.
Could this be the source of his problems?
If so, what course of action would you recommend?
J.S.
The adrenal gland is responsible for the production of several important hormones essential for regulating body function.
Tumours, or nodules, of the adrenal glands are common.
They can be categorized into those that make hormones and those that don’t, and also by whether the tumours are benign or malignant.
The most common, by far, are benign, nonfunctioning tumours.
These usually are discovered on an ultrasound or a CT scan obtained for some other reason.
They go by the whimsical name “adrenal incidentalomas.” More than four per cent of people have an adrenal mass, and 85 per cent of these are nonfunctional.
However, the symptoms your husband has been having raise a concern that he may have a hormone-producing tumour.
There are four types of hormones commonly produced by adrenal tumors: cortisone, aldosterone, sex hormones (estrogen or androgens) and catecholamines (epinephrine and norepinephrine).
A cortisone-producing adrenal tumour causes Cushing’s syndrome, usually causing weight gain, especially in the abdomen, skin changes (including striae, or “stretch marks”), high blood pressure and a predisposition to diabetes.
Anxiety and abdominal pain are uncommon.
Aldosterone raises blood pressure, so a person with a functioning adrenal tumour making aldosterone usually has high blood pressure, but the other symptoms you mention for your husband are not common for this.
Adrenal tumours that make epinephrine and the related norepinephrine are called pheochromocytomas. Hypertension is almost universal with this condition, and anxiety is frequently reported.
Sex-hormone-producing tumours are rare, and they present in men with androgen excess or feminization, in the case of estrogen-secreting tumours.
Although your husband's symptoms are not specific for any one condition, the combination of his symptoms and adrenal nodules concern me.
I agree completely with the recommendation to look for excess amounts of hormone in the blood.
This often can be achieved with a simple blood test; however, occasionally, a catheter is placed in the adrenal vein to sample blood coming from the gland (and its nodule) directly.
By comparing one side against the other, the doctors can determine which side might be producing excess hormone.
An endocrinologist is the expert most likely to have familiarity with these conditions.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu