Adrenal Gland Tumor: Diagnosis

Approved by the Cancer.Net Editorial Board, 03/2016

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu.

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

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

This list describes options for diagnosing this type of tumor, and not all tests listed 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 medical condition

  • The results of earlier medical tests

In addition to a thorough 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 detect a functional tumor. A 24-hour urine sample may also be needed. This test requires a person to collect all of his or her urine for an entire 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 doctors look for with these tests is the stress hormone cortisol. A specific test, called a dexamethasone-suppression test, checks your 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, his or her body will make less cortisol and other hormones. However, if someone has an adrenal gland tumor, cortisol levels will remain high even after taking the drug. Tell your doctor about any medications that you take, even over-the-counter drugs, vitamins, and herbal medications, because this information is needed to correctly interpret the results.

  • Biopsy. A biopsy is the removal of a small amount of tissue 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.  If this is necessary 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.

  • CT or CAT scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles A computer then combines these images into a detailed, cross-sectional view 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 is often 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 uses magnetic fields, not x-rays, to produce detailed images of the body. 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 mass. This procedure is performed only by specialists and is done in a special radiology center. 

After diagnostic tests are done, your doctor will review all of 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. Or, use the menu to choose another section to continue reading this guide.