Symptoms and Management of a Right Adrenal Mass: What You Need to Know

When it comes to adrenal health, one condition that often raises concern is the presence of a mass on the right adrenal gland. These growths, which can be either benign or malignant, may appear as nodules, cysts, or hematomas within the adrenal tissue. While some are discovered incidentally during imaging for unrelated conditions, others present with noticeable symptoms that warrant medical attention. Understanding the potential signs, underlying causes, and treatment pathways is crucial for early diagnosis and effective management.

Common Physical and Compressive Symptoms

A right adrenal mass may not cause any symptoms when small, but as it grows, it can begin to press against nearby organs, leading to discomfort or functional disturbances. On the right side, a large tumor may exert pressure on the liver, potentially causing dull abdominal pain or a feeling of fullness in the upper abdomen. In rare cases, especially if the mass extends significantly, it may even displace surrounding structures downward, affecting normal organ positioning.

Although less common on the right compared to the left, significant enlargement could still influence adjacent anatomy. For instance, very large masses might indirectly affect the diaphragm or gastrointestinal tract, contributing to bloating, reduced appetite, or altered digestion. These mechanical effects are typically associated with tumors exceeding 4 centimeters in diameter.

Hormonal and Endocrine-Related Symptoms

One of the most critical aspects of adrenal masses is their potential to secrete hormones—an issue known as functional or "hyperfunctioning" tumors. Depending on the cell type involved, these tumors can disrupt the body's delicate hormonal balance and lead to distinct clinical syndromes.

Cushing's Syndrome from Cortical Adenomas

If the mass originates in the adrenal cortex and produces excess cortisol, it may result in Cushing's syndrome. Patients often develop characteristic features such as a round, moon-shaped face (moon facies), increased fat deposition around the neck and upper back (buffalo hump), and central obesity with thin limbs. Other systemic effects include high blood pressure, insulin resistance, muscle weakness, mood changes, and easy bruising.

Pheochromocytoma: The "Adrenaline Tumor"

Another notable type is pheochromocytoma—a tumor that arises from chromaffin cells and releases excessive amounts of catecholamines like adrenaline and noradrenaline. This leads to episodic or sustained hypertension accompanied by symptoms such as severe headaches, palpitations, sweating, anxiety, and tremors. These episodes can mimic panic attacks but are medically serious due to the risk of cardiovascular complications, including stroke or heart attack.

Differentiating Benign vs. Malignant Masses

Not all adrenal masses are cancerous. In fact, many are incidental findings—called incidentalomas—that turn out to be non-cancerous cysts or adenomas. However, determining whether a tumor is benign or malignant is essential for guiding treatment decisions.

Tumors smaller than 4 cm are generally monitored over time using periodic imaging (such as CT or MRI scans) and biochemical testing to assess hormone levels. This approach, known as active surveillance, helps avoid unnecessary surgery in low-risk cases. Conversely, lesions larger than 4 cm have a higher likelihood of being malignant or hormonally active, making surgical removal—often via laparoscopic adrenalectomy—the preferred option in most situations.

Signs of Malignancy and Metastasis

Malignant adrenal tumors, such as adrenocortical carcinoma or metastases from other cancers (e.g., lung or breast), tend to grow rapidly and may spread to distant organs like the liver, lungs, or bones. Symptoms in advanced cases may include unexplained weight loss, persistent fatigue, bone pain, or neurological changes depending on the site of spread.

Imaging characteristics such as irregular borders, heterogeneous density, and rapid growth on follow-up scans raise suspicion for malignancy. A multidisciplinary evaluation involving endocrinologists, oncologists, and surgeons is often required to determine the best course of action.

Diagnosis and Next Steps

If you're experiencing symptoms suggestive of an adrenal mass—or if one was found during an unrelated scan—it's important to undergo comprehensive evaluation. This typically includes blood and urine tests to check for abnormal hormone production, followed by high-resolution imaging to assess size, shape, and composition of the lesion.

Early detection and proper classification can make a significant difference in outcomes. Whether the path involves watchful waiting, medication to control hormone levels, or surgical intervention, personalized care based on tumor behavior ensures optimal patient well-being.