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Adrenal gland
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Diagnosing adrenal gland cancer

Diagnosis is the process of finding the cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other reasons for a health problem before making a cancer diagnosis. Diagnostic tests for adrenal gland cancer are usually done when:

  • the symptoms of adrenal gland cancer are present
  • the doctor suspects adrenal gland cancer after talking with a person about their health and completing a physical examination
  • blood or urine tests or an imaging test suggest a problem with the adrenal gland

Many of the same tests used to initially diagnose cancer are used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person’s family may also help the doctor to diagnose adrenal gland cancer.

In taking a medical history, the doctor will ask questions about:

A physical examination allows the doctor to look for any signs of adrenal gland cancer. During a physical examination, the doctor may:

  • check blood pressure and pulse (heart rate)
  • look for any changes in physical appearance
  • feel the abdomen for a lump

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Urine tests

Collection of urine over a 24-hour period may be used to measure the amounts of adrenal gland hormones and the products of their breakdown (metabolites) in the body. The urine test will report the 24-hour urinary free cortisol or catecholamine levels.

  • Higher than normal cortisol levels in the urine suggest the presence of an adrenal gland tumour.
  • Tumours that produce one of the sex hormones (either androgen or estrogen) will have high levels of 17-ketosteroids and 17-hydroxysteroids in the urine.
  • A 24-hour urinary metanephrine level is the best measure of catecholamine secretion. Some laboratories measure epinephrine and norepinephrine.

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are used to diagnose adrenal gland cancer.

  • Low levels of potassium and renin (a hormone that plays a role in the release of aldosterone) may be present if an adrenal tumour is producing too much aldosterone.
  • The levels of adrenal hormones in the blood will be measured if an adrenal gland tumour is suspected.
    • The cortisol level will be abnormally high if an adrenal tumour is making cortisol.
    • The aldosterone level will be high if an adrenal tumour is making aldosterone.
    • The level of dehydroepiandrosterone sulphate (DHEAS) or testosterone will be high in androgen-producing tumours.
    • The level of estrogen will be high in estrogen-producing tumours.
    • The level of epinephrine or norepinephrine is elevated in pheochromocytoma tumours.
  • High levels of follicle-stimulating hormone (FSH) mean that it is unlikely that a person has an adrenal gland tumour that is producing too much androgen or estrogen.
  • Low levels of adrenocorticotropic hormone (ACTH), combined with a high level of cortisol, suggest that a person has an adrenal gland tumour.
    • High levels of both ACTH and cortisol suggest a tumour in the pituitary gland.
  • Chromogranin A (a protein stored and secreted with the other hormones of the adrenal medulla) may be increased with pheochromocytoma tumours.

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Dexamethasone suppression test

A dexamethasone suppression test may be done to measure the cortisol level in the blood. The person takes an oral (by mouth) dose of dexamethasone, which slows the production of cortisol. The blood cortisol level is measured 12 hours later.

  • If an adrenal gland tumour is not present, the level of cortisol will be lower than normal.
  • If an adrenal gland tumour is present, the level of cortisol in the blood remains high or has not changed.

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • find a tumour in the adrenal gland
  • find out the extent, or spread, of the tumour
  • help distinguish adrenal cancer from a benign tumour based on features of the tumour, such as:
    • size of the tumour
    • smooth or irregular margins
    • density of the tumour

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Magnetic resonance imaging (MRI)

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It is used to:

  • find a tumour in the adrenal gland
  • find out the extent, or spread, of the tumour – especially  blood vessel involvement
  • help distinguish adrenal cancer from a benign tumour based on features of the tumour, such as:
    • size of the tumour
    • smooth or irregular margins
    • density of the tumour

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Metaiodobenzylguanidine (MIBG) scan

A MIBG scan is a nuclear medicine imaging test that uses small amounts of the radiopharmaceutical metaiodobenzylguanidine (MIBG) to help locate and diagnose certain types of cancer.

MIBG scans are used to find tumours that develop in the medulla of the adrenal gland (called pheochromocytomas). Tumours that develop in the adrenal cortex do not show up with this test. MIBG is used to:

  • find a pheochromocytoma tumour that doesn’t show up on the CT scan (if the blood chemistry tests suggest that the person has a pheochromocytoma)
  • find out the extent, or spread, of a pheochromocytoma, including metastasismetastasis1. A tumour formed by cancer cells that have spread from the original (primary) site to another part of the body. 2. The spread of cancer cells from the original (primary) site to other parts of the body. Metastasis can occur by direct growth or extension of a tumour into surrounding tissues to other parts of the body

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Ultrasound

Ultrasound uses high-frequency sound waves to make images of structures in the body. It is rarely used to diagnose adrenal gland cancer because CT scans are more commonly used. An ultrasound may find an adrenal gland tumour when it is being done for other medical reasons.

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Chest x-ray

An x-ray uses small doses of radiation to make an image of the body’s structures on film. A chest x-ray may be done to detect the spread of cancer to the lungs.

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Bone scan

A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to detect the spread of cancer to the bones.

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Biopsy

During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample.

A biopsy is rarely done for adrenal gland tumours.

  • Benign and malignant adrenal tumour cells can look alike under the microscope.
  • There is a risk of spreading tumour cells during a needle biopsy.
  • Pheochromocytomas could bleed or rupture during biopsy.
    • When the needle disturbs the tumour, sudden changes in the hormone levels can cause potentially life-threatening symptoms (such as a drop in blood pressure).

Generally, a biopsy is only done when the tumours are outside the adrenal glands. It is used to find out if there is spread from the adrenal tumour or from another cancer. The types of biopsies done are a fine needle aspiration (FNA) or core needle biopsy guided by CT scan or ultrasound.

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See a list of questions to ask your doctor about diagnostic tests.

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