This map explains adrenal cancers step by step: what it is, the types, the tests, the stages, the treatment and its side effects.
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Starts in the outer layer (cortex). Often makes cortisol or sex hormones. Can occur at any age; some are linked to an inherited condition (Li-Fraumeni syndrome).
Starts in the inner layer (medulla), or in similar tissue elsewhere (paraganglioma). Makes adrenaline-like hormones, causing attacks of headache, sweating, palpitations and high blood pressure. Most are not cancer, but some spread. About 1 in 3 is inherited (SDHB, VHL, RET, NF1 and others).
Tap a test on the map to see why it is done.
Please wait for all the reports. Why we wait
Shows the size and features of the lump. Size over 4 cm, irregular shape or high density raises concern for cancer. PET-CT or special scans (Ga-68 DOTATATE) check for spread.
Usually not done. A biopsy of a phaeochromocytoma can cause a dangerous rise in blood pressure, and a biopsy of adrenocortical cancer can spread it. Diagnosis is made after surgery.
Advised for every patient with phaeochromocytoma or paraganglioma, and for adrenocortical cancer (especially when young). If positive, family members can be tested.
Before starting chemotherapy, immunotherapy or targeted therapy, these tests check that you are fit for treatment, and give a starting point to compare with later.
| Test | Why it is done |
|---|---|
| CBC (complete blood count) | Haemoglobin, white cells and platelets. Treatment can lower them. |
| RFT (kidney function) | Many medicines are cleared by the kidneys; the dose may need to change. |
| LFT (liver function) | Many medicines are processed by the liver. |
| Viral markers: HBsAg, anti-HCV, HIV | Hepatitis B can flare up during treatment. If positive, a tablet is given to prevent this. |
| Blood sugar (and HbA1c if diabetic) | Steroids given with chemotherapy can raise blood sugar. |
| ECG and 2D Echo | Check the heart rhythm and pumping before treatment, as some medicines affect the heart. |
Before immunotherapy, also:
| Test | Why it is done |
|---|---|
| Serum TSH (thyroid) | Immunotherapy can affect the thyroid gland. |
| Serum cortisol (morning sample) | Immunotherapy can affect the adrenal and pituitary glands. |
Sometimes needed, depending on your treatment:
Your doctor will choose the tests that apply to you. Some of them are repeated during treatment.
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Only in the adrenal gland. Best chance of cure with complete surgery.
Grown into nearby tissue, lymph nodes or the large vein (vena cava). Surgery is still possible in many.
Spread to the liver, lungs or bones.
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Side effects: surgery · mitotane · chemotherapy
Side effects: surgery · chemotherapy
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On hydrocortisone or mitotane: vomiting, fever, severe weakness or dizziness (possible adrenal crisis; take an extra dose and seek help). Very high blood pressure with headache and palpitations. Both need urgent care.
This information is general. Your own treatment plan may be different. Please discuss it with your doctor.
Written and medically reviewed by Dr Prathyusha Eaga, MD, DM (Medical Oncology). Last reviewed: 12 October 2026. Based on NCCN and ESMO guidelines.
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