Adrenocortical Carcinoma Health Article

Causes and symptoms

Causes

The cause of adrenocortical carcinoma is not known. Infection with bacteria or parasites is linked to other conditions of the adrenal glands, and there could be a connection with adrenocortical carcinoma. There is also evidence that adrenocortical carcinoma in children is caused by some chemical to which they were exposed as fetuses—possibly a chemical that the women carrying the children were exposed to in food, drink, or in the air.

Many tumors of the adrenal cortex have cells with extra copies of chromosomes, the beads of genetic material or DNA. Chemicals in the environment that are known to affect cells and cause mutations are being investigated as possible causes for adrenocortical carcinoma.

Symptoms

Depending on whether or not the tumor interferes with the production of hormones, the tumor may or may not be linked to symptoms during its early growth. A group of Japanese surgeons led by K. Kunieda reported the case of a 52-year-old man who had a tumor weighing more than two pounds at the time it was discovered. The tumor had not been producing extra hormones, and was not producing symptoms.

An adrenocortical tumor that functions produces many symptoms. Some of them are similar to those linked to other conditions, and many of these conditions have names that are based on a collection of symptoms and not on the cause. A combination of the following symptoms, known as Cushing's syndrome, could be caused by a tumor in the pituitary area of the brain, as well as by adrenocortical carcinoma:

• an abnormal accumulation of fatty pads in the face (creating the distinctive "moon face" of Cushing's syndrome); in the trunk (termed "truncal obesity"); and over the upper back and the back of the neck (giving the individual what has been called a "buffalo hump")
• purple and pink stretch marks across the abdomen and flanks
• high blood pressure
• weak, thinning bones (osteoporosis)
• muscle atrophy (due to protein loss)
• low energy
• thin, fragile skin, with a tendency toward both bruising and slow healing
• abnormalities in the processing of sugars (glucose), with occasional development of actual diabetes
• increased risk of infections
• irregular menstrual periods in women
• decreased sex drive in men and difficulty maintaining an erection
• abormal hair growth in women (in a male pattern, such as in the beard and mustache area), as well as loss of hair from the head (receding hair line)

Similarly, virilization syndrome, or the tendency of a child to exhibit adult sexual features, or a female adult to exhibit male features, can be caused by other conditions, such as tumors in the pituitary, or by adrenocortical carcinoma. So, too, with feminization, or the tendency of a male individual to exhibit female characteristics, such as enlarged breasts and fat deposits on the hips.

Diagnosis

Symptoms usually cause a patient to talk with a physician. Blood and urine samples are examined to learn whether hormones are out of balance. Venography, a way of getting a picture of the inside of veins, is a technique that is still used to examine the adrenal glands prior to any decision about surgery. But the magnetic resonance imaging (MRI) scan has replaced venography in many facilities. Computed tomography (CT) scan is also used to examine the adrenal cortex.

Treatment team

Depending on symptoms, the first specialized physician an individual consults may either be an endocrinologist (a physician who focuses on hormones) or a urologist (a physician who focuses on the study of the kidneys and nearby structures). Either one of them, or a medical oncologist (a physician who focuses on treating patients with cancer) will lead the treatment team. A surgeon will be on the team too because in almost all cases removal of the adrenocortical carcinoma to the fullest extent possible is standard procedure.

Nurses will be on the team to help with administering drugs and monitoring the status of the patient. And if the patient is given chemotherapy, technicians skilled in the treatment will be part of the team.