Adrenocortical carcinoma (ACC), or adrenal gland cancer, is a rare cancer that doesn’t have nearly enough awareness. Since January is Adrenal Cancer Awareness Month, we’ll be taking this time to educate patients about adrenal gland cancer symptoms.

Adrenal cancer is known for being diagnosed at a late stage, which can make it quite aggressive and dangerous. This makes knowing your body and adrenal gland cancer symptoms particularly important.

The top adrenal gland cancer symptoms which help in the diagnosis of adrenal cancer depend on location of where the adrenal cancer starts and size of the adrenal gland tumor. Each layer of the adrenal cortex is responsible for the adrenal production of a specific hormone: aldosterone (salt), cortisol (sugar), or androgens and estrogens (sex hormones). About 60% of adrenal gland cancers overproduce the hormone cortisol, contributing to symptoms of Cushing’s syndrome.

Top 6 adrenal gland cancer symptoms:

• High blood pressure
• Weight gain
• Muscle weakness
• Stretch marks
• Increased anxiety and fatigue
• Excessive facial or body hair

Top Adrenal Gland Cancer Symptoms: High Blood Pressure

One of the hallmark adrenal gland cancer symptoms is high blood pressure, or hypertension. In fact, too much cortisol leads to hypertension in about 95% of adults. This is because of an imbalance of factors involving vessel dilation and vessel constriction.

Aldosterone-producing adrenal cancer, although rare, can lead to signs of primary hyperaldosteronism, which also contributes to high blood pressure.

After adrenal surgery, the adrenal gland cancer symptom of high blood pressure will gradually normalize.

Top Adrenal Gland Cancer Symptoms: Weight Gain

Weight gain is one of the most common adrenal gland cancer symptoms. About 60% of adrenal gland cancers overproduce cortisol and lead to rapid weight gain. The mechanism is the same as for patients with non-cancerous adrenal tumors over-producing cortisol.

The difference is that often, the weight gain is very rapid and happens over a much shorter period of time. Patients with adrenal gland cancer can gain significant weight (10—30 lbs.) in just a few weeks. Weight gain as an adrenal gland cancer symptom can also frequently present as central obesity, which occurs around the center of the body and is also called visceral fat.

Learn more about adrenal gland tumors and weight gain.

Top Adrenal Gland Cancer Symptoms: Muscle Weakness or Spasms

Another prominent adrenal gland cancer symptom is muscle weakness or muscle spasms. This, again, is due to excess cortisol production from the adrenal gland and typically occurs in your extremities (arms and legs).

Muscle weakness as an adrenal gland cancer symptom can progress rapidly and be very pronounced.

Top Adrenal Gland Cancer Symptoms: Stretch Marks

The next most common adrenal gland cancer symptom is stretch marks. Also called purple striae, this adrenal gland cancer symptom typically presents as purple-ish marks about ½ inch wide. They can occur anywhere, but they are most typically seen on the abdomen, thighs, upper arms, and breasts.

Figure 1. Stretch marks is one of the top symptoms of adrenal gland cancer

Top Adrenal Gland Cancer Symptoms: Increased Anxiety and Fatigue

Another common adrenal gland cancer symptom is increased anxiety and fatigue.

When an adrenal gland tumor, cancerous or benign, triggers release of the hormone adrenaline (as is seen in pheochromocytomas), the results can be very stressful on your body. The adrenal glands normally release adrenaline in response to danger, but a tumor on the adrenal gland can cause an excess of adrenaline to release at all times. The effect can be similar to a contact panic attack, and further contributes to symptoms of elevated blood pressure, headaches, sweating and more.

Similarly, cortisol has a direct effect on brain function and frequently leads to increased anxiety and fatigue. In fact, too much cortisol and Cushing’s syndrome can lead to frank psychiatric symptoms such as anxiety, depression, confusion, neurosis and psychosis.

Top Adrenal Gland Cancer Symptoms: Excessive Facial or Body Hair

The final adrenal gland cancer symptom we’ll be discussing is excessive facial or body hair, also known as hirsutism in women.

Hirsutism, in addition to being an adrenal gland cancer symptom, can cause a significant psychological burden. It is defined as unwanted hair growth in females that is on the face, chest and back.

Hirsutism is mostly caused by excess androgen secretion either from the ovaries or adrenal glands, and in post-menopausal women, it is exclusively from the adrenal glands.

Adrenal Gland Cancer Symptoms: Summary

Although adrenal gland cancer is a rare disease, its mortality rate makes it important for doctors and patients alike to be aware of adrenal gland cancer symptoms. As with all cancers, early detection is ideal for your best chance at being cured.

Unfortunately, adrenal gland cancer is typically diagnosed at a later stage, which is what makes it an aggressive and dangerous cancer. About 70% of the time, the adrenal cancer has already spread to other parts of the body (abdominal cavity, lungs, liver, and bone) by the time the cancer is detected. If you are part of the 30% whose adrenal gland cancer is confined to the adrenal gland, it is potentially curable.

Figure 2. The CT scan showing an adrenal cancer, which was possible to treat with complete surgical removal.

The only cure for adrenal gland cancer is complete surgical removal. It is extremely important that you select only the most experienced adrenal surgeon for your surgery if you have adrenal gland cancer.

Dr. Tobias Carling, of the Carling Adrenal Center, is one of the world's leading experts in adrenal gland surgery. Dr. Carling performs more adrenal operations than any other surgeon in America. Dr. Carling left Yale University in 2020 to open the Carling Adrenal Center in Tampa, Florida.

To discuss the details of your case with Dr. Carling and become his patient, fill out the new patient form and he will be in touch with you shortly.

Additional Resources: 

• Learn more about the Carling Adrenal Center
• Learn more about Dr. Tobias Carling
• Learn more about our sister surgeons at the Norman Parathyroid Center, Clayman Thyroid Center and Scarless Thyroid Surgery Center
• Learn more about the Hospital for Endocrine Surgery