Adrenal Nodules
Adrenal nodules are masses found in the adrenal glands, typically larger than 1 cm. They’re called “incidentalomas” because they’re usually discovered unintentionally during tests for other conditions. These nodules are surprisingly common, with studies showing they’re present in about 4% of people who undergo abdominal imaging. Their frequency increases with age—think 1 in 500 people under 25 compared to 1 in 30 over the age of 65..
Most adrenal nodules are harmless and don’t cause symptoms. These non-cancerous growths, called adenomas, are essentially just “silent guests” that take up space without making a fuss. However, some nodules may produce excess hormones or, in rare cases, signal a more serious condition, such as cancer.
What Causes Adrenal Nodules?
The causes of adrenal nodules vary. Most are benign adenomas—simple, non-functional growths that don’t disrupt the body’s delicate hormonal balance. However, not all nodules are created equal. Some can:
Overproduce hormones, causing conditions like Cushing syndrome (too much cortisol) or hyperaldosteronism (high blood pressure caused by excess aldosterone).
Signal cancer or other conditions, such as adrenocortical carcinoma (a rare but aggressive cancer), pheochromocytoma (a tumor that causes hormone surges), or metastases from other cancers.
Be non-cancerous but unusual, such as cysts or myelolipomas (fatty tissue growths).
Diagnosing Adrenal Nodules
Once an adrenal nodule is discovered, the next step is figuring out what it means for your health. This typically involves a combination of imaging tests and blood or urine tests:
Imaging Tests: A CT scan can reveal important details about the nodule’s size, shape, and density. Doctors use a measurement called Hounsfield units (HU) to differentiate between benign and potentially harmful nodules. For example, a noncontrast HU of less than 10 usually indicates a benign adenoma.
Hormone Testing: Some adrenal nodules produce hormones that can disrupt the body’s balance. Blood or urine tests help detect excess cortisol, aldosterone, or adrenaline, which may point to conditions like Cushing syndrome or pheochromocytoma.
The goal is to answer two key questions: Is the nodule cancerous? Is it affecting your hormone levels? Once these are determined, the next steps become clearer.
Managing Adrenal Nodules
The treatment or follow-up plan for adrenal nodules depends on their size, appearance, and activity:
Small and Inactive (<4 cm): Most nodules under 4 cm that don’t produce hormones or look suspicious on imaging can simply be monitored. These nodules rarely grow or turn cancerous, so periodic imaging and hormone testing are often sufficient.
Large or Concerning (>4 cm): Nodules over 4 cm or those with concerning features on imaging (e.g., uneven borders or high HU) may require surgical removal to rule out cancer.
Hormonally Active Nodules: If a nodule produces excess hormones, it often needs to be treated, as hormonal imbalances can lead to significant health issues. Surgery is usually the best option in these cases.
Why Work with an Endocrinologist?
Adrenal nodules may seem straightforward, but their evaluation and management require specialized expertise. That’s where an endocrinologist comes in. Endocrinologists, like Dr. Hasan, are trained to assess adrenal disorders and hormonal imbalances with precision. They can identify subtle signs of trouble, recommend appropriate tests, and tailor a plan to your unique needs. By working with an expert, you can ensure that no stone is left unturned in safeguarding your health.
Monitoring and Follow-Up
For small, benign-looking nodules, monitoring is the name of the game. Most guidelines recommend follow-up imaging at 6 to 12 months, with annual checks for a year or two to confirm stability. Hormone testing is often repeated during this time to ensure the nodule isn’t becoming hormonally active.
Can Adrenal Nodules Be Prevented?
Unfortunately, adrenal nodules can’t be prevented—they’re often a random finding. However, maintaining good overall health can help mitigate risks if you develop a hormonally active nodule. Controlling blood pressure, managing metabolic conditions, and staying proactive about your health are all helpful steps.
The Takeaway
Adrenal nodules might sound intimidating, but most are harmless and require little more than occasional monitoring. For those that need closer attention—whether due to size, suspicious features, or hormone activity—modern diagnostic tools and treatments ensure effective management.
If you’ve been told you have an adrenal nodule, it’s important to stay informed and work closely with a specialist. Dr. Hasan at Chia Endocrinology & Wellness has extensive experience diagnosing and treating adrenal disorders.