Race and ethnicity
There is no racial or ethnic preference for adrenocortical carcinoma.
Several reports suggest that, for unknown reasons, incidence is disproportionately high among children in southern Brazil.Causes and risk factors
Risk factors for adrenal cancer have not been established. This is because they are very rare, making epidemiological studies fruitless and difficult.
At genetic level, adrenal tumors exhibit following abnormalities.
Men who smoked more than 25 cigarettes per day had an increased risk (odds ratio 2:0; 95% confidence interval [CI] 1.0–4.4).
Women who used oral contraceptives, especially those under 25 years of age, had an increased risk of developing adrenocortical carcinoma (odds ratio 1:8; 95% CI 1.03.2).Symptoms and signs
Approximately 60% of patients experience symptoms associated with excessive production of hormones (cortisol, aldosterone, androgens and estrogens). Functional tumors can present with any of following hormonal syndromes:
40% of cases are non-functioning carcinomas and thus may be a sign of local tumor invasion or metastasis. The main symptoms are a large abdominal mass, abdominal pain, or weight loss.
CT allows you to reliably differentiate hyperplasia of cerebral cortex from tumors.
By way, an adrenal tumor is found in 1-3% of patients who undergo abdominal CT. Most of these lesions were benign, and adrenocortical adenomas were 60 times larger than primary carcinomas.
Criteria for malignancy
Magnetic resonance imaging
MRI can distinguish adenoma from carcinoma from pheochromocytoma. Loss of chemical shift signal in adrenocortical carcinoma.
Positron emission tomography (PET) studies used fluorodeoxyglucose or C11 methionine. A better imaging indicator may be 11C-midimidate. Although this indicator cannot distinguish between benign and malignant tumors, absorption outside adrenal glands may indicate recurrence or metastasis in patients undergoing adrenocortical carcinoma resection.
The test has low diagnostic sensitivity for adrenal tumors and is highly user dependent in terms of interpretation and quality of results. However, it is especially useful in follow-up of previously discovered incidental tumors.
The echogenic texture of malignancies is variable and heterogeneous in appearance, with lesions or scattered anechoic or echogenic areas representing areas of tumor necrosis, hemorrhage, or calcification.
Angiography and venography of adrenal glands
Selective angiography and adrenal venography are ineffective in diagnosing adrenal neoplasms. This can help differentiate smaller lesions and help differentiate adrenal tumors from tumors in upper pole of kidney. Vena cava contrast examination and angiography may provide additional staging information and allow for a more complete preoperative assessment.
Most adrenocortical carcinomas cannot be visualized with 131 I-6β-iodomethylcholesterol. Because cortisol production suppresses ACTH secretion and contralateral adrenal function, patients with cortisol-producing adrenal tumors cannot visualize location of tumor or contralateral adrenal gland. CT and iodomethylcholesterol imaging can be used to diagnose small (less than 4 cm) normal adrenal masses. CT images (CT image and increased absorption on ipsilateral side) were benign in 100% of cases, while discordant images (CT image of tumor on one side and increased absorption on contralateral side) were malignant in 73% of cases.
Adrenal Function Test
Additional studies may include appropriate endocrine studies. Serum or urine steroid profiles can help differentiate benign from malignant adrenal tumors due to presence of intermediate precursors in steroid biosynthetic pathway or metabolites in patients with malignant tumors.
Fine-needle aspiration and core-needle biopsy
Fine needle aspiration should never be performed on any neoplasm of adrenal gland unless pheochromocytoma has been previously excluded; otherwise, procedure can be fatal.
Because histological analysis of these lesions can be uncertain, fine-needle and/or core-needle biopsy (percutaneous approach) is generally not recommended unless metastases are suspected.
Fine needle and/or percutaneous biopsy can be performed under CT or ultrasound guidance. Currently, only reason for this is to screen patients with known malignancy to rule out adrenal metastases.