How to check whether adrenal tumors are functional?

Whether an adrenal tumor is functional can be determined by blood and urine tests to assess hormone levels, and imaging tests to determine the size, shape, and nature of the tumor. If a functional tumor is suspected, relevant tests should be performed as soon as possible to confirm the diagnosis and develop a treatment plan, including drug control, surgical resection, or regular follow-up.

1. Check hormone levels

Functioning adrenal tumors secrete abnormal hormones, so evaluating hormone levels is central to diagnosis.

- Blood tests: to measure the levels of cortisol, aldosterone, and sex hormones in the blood, as well as the level of adrenocorticotropic hormone (ACTH). For example, high cortisol levels may indicate Cushing's syndrome, while high aldosterone levels may be associated with primary aldosteronism.

- Urine tests: 24-hour urine free cortisol or urine catecholamine testing can reflect long-term hormonal abnormalities, such as pheochromocytoma causing elevated catecholamine levels.

2. Imaging examination

Imaging examinations are very important for determining the nature and function of the tumor.

-CT scan: This is used to assess the size, density, and presence of calcification or other abnormal features of the tumor. Functioning tumors tend to be small, while non-functioning tumors may be larger.

-MRI: It has good soft tissue display and can be used to further identify the nature of the tumor. For example, MRI has a high sensitivity in the diagnosis of pheochromocytoma.

-Positron emission tomography (PET-CT): When necessary, it is used to determine whether the tumor is metabolically active and help rule out malignant lesions.

3. Dynamic hormone test

When basic tests are unable to provide a definitive diagnosis, dynamic tests can be performed to identify functional abnormalities.

- Low-dose dexamethasone suppression test: used to screen for Cushing syndrome. If dexamethasone fails to suppress cortisol levels, it indicates the presence of a hormone tumor.

-Standing-lying aldosterone test: to determine whether aldosterone secretion is autonomous. Functional adenomas often show elevated aldosterone levels that are independent of body position.

- Adrenal vein blood sampling: used to determine whether the tumor is a unilateral lesion, especially before planning surgery, which is very critical.

4. Treatment options

Treatment options may vary based on test results:

-Drug control: For patients who cannot undergo surgery immediately, drugs can be used to control hormone secretion, such as ketoconazole to inhibit cortisol synthesis, or spironolactone to control aldosterone levels.

-Surgical resection: Functional tumors often require surgical resection, which can be done through laparoscopy or open surgery.

- Long-term follow-up: Cases with non-functioning tumors or low likelihood of malignancy can be managed with regular imaging and hormonal monitoring.

The importance of determining the functionality of adrenal tumors lies in the fact that uncontrolled hormone secretion may cause serious complications, such as high blood pressure and high blood sugar. Through methods such as hormone testing, imaging and dynamic testing, it is possible to accurately determine whether the tumor is functional and help develop the best treatment strategy. It is recommended to seek medical treatment in a timely manner and seek professional diagnosis and treatment advice.