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Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Adrenal Nodules

Overview

You have 2 adrenal glands, 1 located on top of each kidney. The adrenal glands make several hormones that regulate your body’s metabolism, response to stress, and salt and water balance. Adrenal nodules are growths on these glands.

When a nodule is present, you will usually have no symptoms. Nodules smaller than 4 centimeters (cm), or 1½ inches, are the most common ones found, and these are almost always benign. Nodules more than 4 cm in size tend to be of more concern and may require surgery. 

Most adrenal nodules do not cause health problems. However, adrenal nodules sometimes produce hormones that can cause serious medical problems. We refer to these as functioning nodules.

Most adrenal nodules are benign (noncancerous), but there are rare adrenal nodules that are malignant (cancerous).

Types

There are 4 main types of adrenal gland nodules:

Adrenal incidentaloma. This is the most common type of adrenal tumor. It is benign (not cancerous) and often causes no symptoms. Small nonfunctioning adrenal adenomas frequently do not require treatment.

Functioning adrenal adenoma. Adrenal adenomas that make hormones can cause problems and usually need to be removed.

Adrenal nodule carcinoma. This is a very rare type of cancer that forms in the adrenal gland. The nodule can be functioning or nonfunctioning.

Pheochromocytoma. This type of nodule makes excess hormones that can cause high blood pressure, headaches, anxiety, rapid heartbeat, and other symptoms. Pheochromocytoma is rare and usually benign.

Symptoms

A nonfunctioning adrenal nodule will generally not cause symptoms.

A functioning adrenal nodule can cause different symptoms depending on which hormones are produced. Symptoms may include:

  • Changes in face and body shape
  • Acne
  • Unexplained weight gain or loss
  • High blood pressure
  • Muscle weakness
  • Diabetes
  • Increase in body hair in women
  • Episodic headaches and/or abdominal pain
  • Excessive sweating
  • Abnormal fatigue
  • Sexual dysfunction

The majority of adrenal nodules are not cancerous. If an adrenal nodule is cancerous, it may produce no symptoms (nonfunctioning), or it may cause the same symptoms as a functioning benign adrenal nodule.

Diagnosis

Most of the time, we will order tests to make sure the adrenal glands are not making excessive hormones. These tests may include :

  • Blood and urine tests, which can show the amount of hormones produced
  • Medication taken at night followed by a blood test done the next morning

Sometimes additional scanning tests may be necessary.

If an adrenal nodule is not making any extra hormones (nonfunctioning), we generally monitor the size of the nodule with imaging tests such as CT scan.

Treatment

It is important to remember that most of the time (over 95%) adrenal nodules are not worrisome and need no treatment after the initial evaluation. However, if the adrenal nodule is producing excessive hormones, growing, or very large (over 4 cm), we may advise an operation to remove the adrenal gland with the nodule.

Nonfunctioning small adrenal nodules (adrenal incidentalomas) do not need any treatment other than continued observation with periodic imaging scans.

Functioning adrenal nodules, any large adrenal nodules, or nodules that are growing may be surgically removed.

If an adrenal nodule is causing high blood pressure, we may prescribe medications to control your blood pressure until surgery is performed.

Surgery for adrenal nodules

Laparoscopic adrenalectomy is the most common surgery used to remove an adrenal nodule. For this minimally invasive procedure, a surgeon makes small incisions in your abdomen and inserts long, thin instruments through the incisions. These instruments carry tiny fiber-optic cameras, which enable the surgeon to guide the instruments precisely to the adrenal gland. The adrenal gland containing the nodule is then removed using the instruments, through the small abdominal incisions. 

A variation on this procedure is hand-assisted laparoscopic surgery (HALS), which utilizes special devices that permit the surgeon to insert a hand inside the abdomen through a 2-inch incision, thus making it easier to remove larger tumors.

Open surgery involving a larger abdominal incision may be required in some instances. To remove very large adrenal nodules (5 to 6 cm or larger), the surgeon will make a larger incision through the abdomen or back.

After surgery, you may need to take steroid medications for a period of time to replace the hormones that the removed gland no longer supplies. However, in most cases, the remaining adrenal gland will eventually compensate for the missing one and produce enough of these hormones on its own.

Treatment of cancerous nodules

If the adrenal nodule is cancerous and has spread to other organs, then chemotherapy and radiation therapy may be used to treat the cancer following surgery.

Lifestyle Management

After the removal of an adrenal nodule, you will require periodic follow-up examinations, including imaging scans and blood and urine tests.

If you have had both of your adrenal glands removed, you will probably have to take hormone replacement medications for the rest of your life. You should also wear a MedicAlert bracelet at all times.

After losing an adrenal gland, it is particularly important for you to maintain a healthy diet and weight, and not to smoke. Moderate exercise can help you gradually regain your energy and strength.

Additional References:

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.