If you have an adrenal tumor, your physician team needs to learn more about it in order to determine the best treatment options for you. In addition to a physical exam, and discussion of your personal and family medical history, your team will perform some of the following tests to diagnose the type of tumor and determine whether it is cancerous or if it has spread. Some of these tests are used only for specific types of adrenal tumors and to help to guide treatment.
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
A CT scan is like an x-ray linked to a computer that takes a series of pictures and provides very detailed images from inside the body. Patients may receive an intravenous injection of contrast dye so that 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 produce images of inside the body. An Adrenal-Procotol MRI look specifically at 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.
FDG-PET/CT scan
This type of PET and CT scan uses radioactive type of glucose (18-fluorodeoxyglucose) which is taken up by active cancer cells faster than normal cells. This test is not helpful for determining the type of adrenal tumor (including whether it is cancer) but can be helpful to determine the extent of spread in advanced adrenal cancers that have spread to other parts of the body.
SSRT-PET/CT scan (Netspot scan)
The hormone somatostatin helps control other hormones in the body. It binds to somatostatin receptor (SSTR) antagonist, a protein found on the surface of many cells. This type of PET/CT scan uses a tracer that binds to SSTRs.
Biopsy
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.