Adrenal Gland Tumor: Diagnosis

Approved by the Cancer.Net Editorial Board, 10/2022

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, a tumor. They also do tests to learn if a tumor is cancerous and, if so, whether it has spread to another part of the body from where it started. If the tumor does spread, it is called metastasis. Some tests may also determine which treatments may be the most effective.

To diagnose an adrenal gland tumor, the doctor will do blood and urine tests (see below) to look for the presence of certain substances to help determine whether the tumor is functional or nonfunctional (see Introduction). Imaging tests show pictures of the inside of the body and may be used to see if a cancerous tumor has spread. A computed tomography (CT or CAT) scan or a magnetic resonance imaging (MRI) scan (see below) may be useful in making a diagnosis and finding out whether an adrenal gland tumor is cancerous. Doctors may also do tests to learn which treatments could work best.

How an adrenal gland tumor is diagnosed

There are different tests used for diagnosing an adrenal gland tumor. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of tumor suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose an adrenal gland tumor:

  • Blood and urine tests. Blood and urine tests help measure the amount of adrenal hormones, which can tell the doctor if the tumor is functional or nonfunctional. A 24-hour urine sample may also be needed. This test requires a person to collect all of their urine for a 24-hour period, so it can be used for laboratory testing. The test results help the doctor track how quickly various hormones are produced.

    One specific hormone that doctors look for with these tests is the stress hormone called cortisol. A specific test, called a dexamethasone-suppression test, checks cortisol levels. For this test, you may be asked to take a pill the evening before. This pill contains a drug that acts like cortisol in the body. When someone who does not have an adrenal gland tumor takes this drug, their body will make less cortisol and other hormones. However, if someone has an adrenal gland tumor producing cortisol, cortisol levels will remain high even after taking the drug. Tell your doctor about any medications that you take, even any over-the-counter drugs, vitamins, and herbal supplements, because this information is needed to correctly interpret this test's results.

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. If the doctor suspects that cancer has spread to the adrenal gland from another part of the body, a biopsy may be done to find out where the cancer began, which can help the doctor plan treatment. During biopsy, a narrow, hollow needle is used to collect the tissue. This is called a fine-needle biopsy or fine-needle aspiration. The biopsy is performed by a radiologist who uses specialized imaging procedures, such as CT scans (see below), to guide the needle directly into the tumor. A pathologist then analyzes the sample(s) removed during the biopsy. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. An evaluation of hormone production should be done before a biopsy of an unknown adrenal mass to make sure that the tumor is not producing catecholamines.

  • CT or CAT scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer then combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein through a peripheral intravenous (IV) line. This line is a short, plastic tube inserted into the vein that allows the health care team to give medication or fluids.

  • MRI. An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Metaiodobenzylguanidine (MIBG) scan. MIBG is a chemical similar to adrenaline that will collect in a neuroendocrine tumor. A MIBG scan can show a tumor of the adrenal medulla that may not show up on an x-ray. The scan takes place over 2 consecutive days. On the first day, an injection of MIBG is given in the arm. Several hours later, pictures are taken with a special camera that can show if or where in the body the MIBG has collected. The following morning, more pictures are taken, and the process may be repeated if needed.

  • Adrenal vein sampling (AVS). In rare cases, a patient may have symptoms of a hormone-producing tumor, but CT or MRI scans may not identify a tumor or the patient may have small masses on both adrenal glands. In cases like this, an interventional radiologist can test the blood from the veins of each adrenal gland. The blood from each gland is tested to determine whether extra hormone is coming from the adrenal gland with the tumor. This procedure is performed only by specialists and is done in a special radiology center.

  • DOTATATE positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET or PET-CT scan. During this test, a small amount of a radioactive drug, called a tracer, is injected into a patient’s vein. The body is then scanned to show where the radioactivity has built up in the body. However, the amount of radiation in the substance is too low to be harmful. For pheochromocytoma that is suspected to be inherited, is recurrent, or is at multiple sites, a special PET scan using a special compound called DOTATATE is done. This is a newer scan that is useful in the assessment of these conditions. Learn more about pheochromocytoma.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is a tumor, these results also help the doctor describe it. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.