How Adrenocortical Carcinoma Is Diagnosed

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Adrenocortical carcinoma is also known as cancer of the adrenal cortex, which is the outer layer of the adrenal gland. The adrenal glands are glands found on top of the kidneys. They produce hormones that regulate bodily functions. In the early stages, adrenocortical carcinoma often doesn’t cause noticeable symptoms. 

Many people with this type of cancer find out they have it incidentally through imaging or tests for other conditions. For example, adrenal cortex cancer may be discovered when someone is undergoing imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) for entirely different reasons.

An issue with the adrenal gland may also crop up when someone gets their hormone levels checked. For instance, a doctor may suspect a person has Cushing’s syndrome and find cause to investigate further after blood tests show elevated hormone levels.

To make a diagnosis of adrenocortical carcinoma, a doctor will ask about your medical history, perform a physical exam, and order a blood test, a urine test, and imaging studies. 

This article looks at how doctors diagnose adrenocortical carcinoma and outlines the different tests and imaging studies involved in a diagnosis.

A person sits on an examination table holding the hand of their doctor.

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Physical Examination

A physical exam will involve taking your medical history. Your doctor will ask you about any symptoms you’re feeling. Questions may include:

  • Do you have any pain in your back or abdomen?
  • Are you experiencing a feeling of fullness in your abdomen?

In some cases, an adrenocortical tumor may overproduce certain hormones such as cortisol, aldosterone, testosterone, and estrogen.

Some symptoms may be easy to spot, such as having a round, full face, also known as moon face. However, others may not be as noticeable. Signs that the doctor can check for include high blood sugar or high blood pressure. 

If you are a person who menstruates, the doctor may ask whether you’ve had periods recently because high testosterone or estrogen can affect the menstrual cycle. In males, high estrogen can impact sex drive and cause impotence, which the doctor may also ask about.

The doctor may further ask whether you have any family history of cancer, specifically adrenal cortex cancer. They may also ask if you have one of the following hereditary conditions:

People with these conditions may have a higher risk of developing adrenocortical carcinoma.

If a tumor gets big enough, it may cause you to develop a palpable lump in your abdomen. A doctor may gently palpate the area to check for lumps.

A doctor can’t diagnose you based solely on a physical exam. Even if you have some symptoms, such as pain in the abdomen and high blood pressure, these alone don’t mean you have cancer. Further testing is required to make a diagnosis.

Labs and Tests

Tests that a doctor may use to diagnose adrenocortical carcinoma include urine and blood tests.

A urine test checks for levels of cortisol or 17-ketosteroids. If either of these levels is high, it may indicate a problem with the adrenal cortex. However, it does not necessarily mean the problem is cancer.

Blood tests to check for issues with the adrenal cortex include:

Dexamethasone suppression tests may involve low or high doses of dexamethasone. If a small quantity is given, this looks at whether the adrenal gland is overproducing cortisol. The test involving a high dose of dexamethasone checks whether the adrenal or pituitary gland is the culprit of cortisol overproduction.

A blood chemistry study checks for unusual levels of things like sodium, which may indicate the presence of disease.

Biopsy

If a growth is detected during imaging, a doctor may perform a biopsy using a needle to collect a sample from it. This is then prepared and examined by a pathologist (a doctor specializing in laboratory science) for evidence of cancer.

Has the Cancer Spread?

If imaging and a biopsy have found cancer, a doctor may also perform tests and imaging to determine the cancer’s stage and whether it has spread to other parts of your body.

In some cases, doctors may suggest removing the adrenal gland in a procedure called adrenalectomy. They will then send a sample to a pathologist who can check whether the tissue is cancerous. 

Imaging

If your physical exam and lab tests are cause for concern, a doctor may request imaging to get a better look inside your body. Imaging tests may include:

Computed Tomography (CT) Scan

A CT scan uses X-rays to produce images of your internal organs and tissues. You may need to ingest or be injected with a contrast dye, which will allow for better visualization.

MRI 

MRI technology uses magnets and radio waves to produce images of the inside of your body. If a doctor suspects you have adrenocortical carcinoma or a problem with the adrenal gland, they will order an abdominal MRI.

Positron Emission Tomography (PET) Scan

A PET scan looks for malignant cancer cells via injected radioactive sugar (glucose). Because malignant cells absorb more glucose, they’re easy to spot on a PET scan.

Adrenal Angiography

During this procedure, a medical professional injects a contrast dye into your adrenal arteries (the blood vessels that supply these glands) to check for blockage.

Adrenal Venography

This procedure is similar to adrenal angiography, except it looks for blockages in the veins instead of the arteries. The medical professional may also take a blood sample directly from the adrenal veins during this procedure to check hormone levels.

MIBG Scan

During this procedure, a medical professional injects you with a tiny amount of MIBG, a radioactive material. Doctors use this type of scan to check for a differential diagnosis of pheochromocytoma, a different kind of tumor of the adrenal gland.

Adrenocortical Carcinoma Staging

Doctors stage adrenocortical carcinoma according to tumor size and whether the cancer has spread outside of the adrenal gland:

  • Stage I: The tumor is smaller than a lime—5 centimeters (cm) or less—and hasn’t spread elsewhere.
  • Stage II: The tumor is about the size of an egg or larger (larger than 5 cm) and hasn’t spread yet. 
  • Stage III: The tumor can be any size at this stage, but it has spread to nearby lymph nodes or tissues.
  • Stage IV: At this stage, the tumor can be any size and has spread to nearby lymph nodes and farther parts of the body, such as the lungs.


Differential Diagnoses

Some conditions can cause symptoms similar to adrenocortical carcinoma.

Mineralocorticoid excess is an inherited disorder that causes high blood pressure, excess levels of aldosterone, and low potassium. These are symptoms that may show up in someone with a hormone-producing adrenal cortex tumor.

Other diseases of the endocrine system can also cause elevated hormone levels, such as Cushing’s syndrome, which causes: 

  • Weight gain
  • Moon face
  • Easy bruising
  • Thin extremities and thick trunk and neck
  • Muscle weakness 

While adrenocortical carcinoma can cause Cushing’s, other things may also cause high cortisol levels, such as:

Adrenal cysts can also cause similar symptoms, as can other benign tumors. Cancer can also spread from elsewhere to the adrenal glands.

Summary

Adrenocortical carcinoma is often suspected due to laboratory testing or imaging for other conditions. To further explore the diagnosis, a doctor performs a physical examination and medical history, and orders blood and urine lab tests to look for hormonal and metabolic abnormalities.

Imaging studies will look for tumors on the adrenal glands and whether there is spread to other parts of the body. A biopsy might be taken of a suspected tumor and examined to determine if it is adrenocortical carcinoma.

A Word From Verywell

Although it may be concerning, one out-of-normal-range test result does not mean you necessarily have cancer. Many conditions can cause issues with hormone levels. Doctors need more information to confirm abnormal findings and look for the underlying cause.

Other symptoms, such as pain in your abdomen or back, could likewise stem from ailments other than cancer. Bring such issues to the attention of your healthcare team, and follow through with testing and imaging to find what may be the cause.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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