Adrenal Cancer Diagnosis: Right From the Start
Getting the right diagnosis means getting the right treatment and, ultimately, having better outcomes.
If adrenal cancer is suspected, your doctor may perform one or more of the following procedures depending on the symptoms present:
- Physical Exam
The doctor checks general signs of health, feeling for lumps or other signs of abnormality.
- 24-Hour Urine Test
In this test, urine is collected for 24 hours to measure the amounts of hormones made by the adrenal gland, including cortisol, certain types of adrenaline, and derivatives of estrogen and testosterone (17-ketosteroids). A higher than normal amount of these in the urine may be a sign of disease in the adrenal gland.
- Blood Chemistry Study
A procedure in which a blood sample is checked to measure the amounts of certain substances, such as potassium or sodium, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of overactive adrenal tissue, as in some adrenal tumors.
- Adrenal Vein Sampling and Venography
A procedure to look at the adrenal veins and sample the blood near the adrenal gland. A catheter (very thin tube) is inserted into the vein to take a blood sample, which is checked for abnormal hormone levels. A contrast dye may be injected into the vein to check for blockage.
- Dexamethasone Suppression Test
A test in which one or more small doses of dexamethasone steroid are given to suppress cortisol hormone production by the adrenal gland. The level of cortisol produced can then be checked from a sample of blood or from urine that is collected over 24 hours. The cortisol level after dexamethasone suppression can help determine whether there is overactive adrenal tissue, as seen in some adrenal tumors.
- CT scan (CAT scan)
An x-ray machine linked to a computer takes a series of detailed pictures of the adrenal gland and any tumors present. Patients may receive an intravenous injection of contrast dye so the adrenal gland can show up clearly.
- Magnetic Resonance Imaging (MRI)
MRI is an imaging machine that uses a large magnet, a computer and radio waves to look inside and evaluate parts of the body, including the adrenal gland.
- Positron Emission Tomography Scan (PET)
One of the more revolutionary imaging devices, the combined PET/Computed Tomography (CT) scanner is currently used to give a total-body overview of glucose (sugar) metabolism, which can reveal metabolic changes of cancer before anatomic abnormalities can be detected with conventional imaging tools such as stand-alone CT and ultrasound.
- MIBG Scan
A small and safe amount of radioactive material (MIBG) is injected into a vein and travels through the bloodstream. Adrenal gland cells take up the radioactive material and are detected by a device that measures radiation. Overactive adrenal tissue present in some adrenal tumors (pheochromocytomas) may take up more radioactive material, allowing their location in the body to be confirmed. This scan is done to detect the presence of an adrenal pheochromocytoma that is making excess amounts of adrenaline-type hormones.
A physician may remove cells or tissues so they can be evaluated under a microscope by a pathologist who looks for signs of cancer. The sample may be taken using a thin needle, called a fine-needle aspiration (FNA) biopsy or a wider needle, called a core biopsy. Unfortunately, it is quite difficult to determine whether an adrenal nodule is benign or cancerous by this technique, and there is a risk to cause dangerously high levels of hormone to be released by the adrenal gland during biopsy. Needle core biopsies are therefore not routinely performed for adrenal masses.