Adrenocortical adenoma and carcinoma
- Lesion
Adrenal lumps are often found by chance on scans. Most are small harmless adenomas; large ones may be cancer.
What it is
Adrenocortical neoplasms range from small, common, non-functioning adenomas to rare, aggressive carcinomas. Functioning tumours cause Cushing syndrome, hyperaldosteronism or virilisation. Because modern imaging finds adrenal masses in a few percent of adults, the incidentaloma is a frequent clinical problem: the questions are whether it secretes hormones and whether it could be malignant. Metastases to the adrenal are more common than primary carcinoma.
Structure
- Adenoma: lipid-rich, clear to eosinophilic cells resembling fasciculata; mild nuclear variation; thin capsule.
- Carcinoma: diffuse sheets, necrosis, high mitotic rate, atypical mitoses, capsular and venous invasion; scoring systems combine these features.
- Carcinoma cells express SF1, inhibin, Melan-A and calretinin and lack the epithelial markers typical of metastatic carcinoma.
- Myelolipoma: fat with erythroid, myeloid and megakaryocytic precursors.
- Pseudocyst: fibrous wall without epithelium, old blood.
Adrenal masses compared
| Lesion | Size and look | Hormones | Behaviour |
|---|---|---|---|
| Adenoma | Small, yellow, lipid-rich | Usually none; sometimes cortisol or aldosterone | Benign |
| Carcinoma | Large, variegated, necrotic | Often cortisol and androgens | Aggressive, invades veins |
| Metastasis | Often bilateral | None (can cause insufficiency) | Depends on primary |
| Pheochromocytoma | Grey-brown, haemorrhagic | Catecholamines | Can metastasise |
| Myelolipoma | Fat with marrow elements | None | Benign; can bleed when large |
| Cyst or pseudocyst | Fluid-filled | None | Benign |
Clinical notes
- Every incidentaloma is tested for cortisol excess, catecholamines and, if hypertensive, aldosterone.
- Size and imaging density (lipid content) guide the risk of malignancy; larger, lipid-poor masses are suspicious.
- Mild autonomous cortisol secretion raises cardiovascular risk.
Test yourself
Think of the answer, then tap the question to see it.
Why is the adjacent cortex atrophic next to a cortisol-secreting adenoma?
Cortisol from the tumour suppresses pituitary ACTH, so normal cortex loses its stimulus.
Which inherited syndromes predispose to adrenocortical carcinoma?
Li-Fraumeni syndrome (TP53) and Beckwith-Wiedemann syndrome; also MEN1 and Lynch syndrome.
What is an adrenal myelolipoma?
A benign lesion of mature fat mixed with haematopoietic cells of all lineages.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Adrenocortical Carcinoma Treatment (PDQ®)–Health Professional Version (National Cancer Institute, 2025).
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Representative model, for educational purposes only.