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Non-functioning adrenal masses
Medical expert of the article
Last reviewed: 12.07.2025
[ Causes nonfunctioning adrenal masses
In adults, the most common non-functioning adrenal formation is adenoma (50%), carcinoma (30%) and metastatic tumors (10%). The rest are cysts and lipomas. However, the proportions depend on the clinical manifestations; adenomas are more often detected incidentally. Less often, in newborns, spontaneous hemorrhage into the adrenal gland can cause the appearance of large formations in the adrenal region, simulating neuroblastoma or Wilms' tumor. In adults, bilateral massive hemorrhage into the adrenal gland can be caused by thromboembolic disease, coagulopathy. Benign cysts are observed in elderly patients, can be caused by cystic degeneration, vascular disorders, bacterial infection, parasitic invasion (echinococcus). Also, adrenal formations can be caused by hematogenous spread of tuberculosis. Nonfunctioning adrenal carcinoma causes a diffuse infiltrative retroperitoneal process. Bleeding may occur, causing adrenal hematomas.
Symptoms nonfunctioning adrenal masses
Nonfunctioning adrenal masses are usually discovered incidentally on CT or MRI scans performed for other reasons. Nonfunction is diagnosed clinically and confirmed by measuring adrenal hormone levels as described above. Adrenal insufficiency is rare in adrenal masses unless both glands are involved.
Diagnostics nonfunctioning adrenal masses
The main features of bilateral massive adrenal hemorrhage are abdominal pain, falling hematocrit, signs of acute adrenal failure, suprarenal masses on CT or MRI. Adrenal tuberculosis may cause calcification and Addison's disease. Non-functioning adrenal carcinoma usually presents as metastatic disease and is therefore not amenable to surgical treatment, but chemotherapy control may be achieved with mitotane with maintenance exogenous glucocorticoid therapy.
Small adrenal adenomas (< 2 cm) are usually nonfunctional, asymptomatic, do not require specific treatment, only periodic monitoring for the possibility of growth and the appearance of secretory function (periodic determination of electrolytes and search for clinical signs). If metastatic disease is possible, fine-needle biopsy may be used.
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Treatment nonfunctioning adrenal masses
If the tumor is solid, of adrenal origin, more than 4 cm, removal is necessary, since biopsy does not always differentiate benign from malignant tumors.
Tumors 2–4 cm in size are a challenging clinical problem. If the scan does not suggest cancer and hormonal function is normal (eg, normal electrolytes and catecholamines, no evidence of Cushing's syndrome), periodic observation may be possible. However, many of these tumors secrete cortisol in amounts insufficient to cause symptoms, so it is unknown whether they will cause symptoms and disease. Most clinicians rarely follow these patients.