Very rare, cancer of the adrenal glands is potentially aggressive if it is discovered at an advanced stage. Among these cancers, corticosurrenalomas and pheochromocytomas.
Cancer of the adrenal glands is located at the level of the kidneys. Each of the two kidneys is actually “styled” with a adrenal gland. These glands participate in the secretion of hormones. Cancer can touch one of the two adrenals or both. This is the cancer which was reached by Belgian actress Emilie Dequenne, who died at only 43 years old, on March 16, 2025 after less than two years of struggle.
Various types of tumors can develop in the adrenal gland, some being benign (the most frequent), other malignants. Among the malignant tumors, so cancers, we can see:
- Corticosurrenalomas that develop in the cortical area of the adrenal gland,
- and malignant pheochromocytomas, at the medullary area. The pheochromocytomas are nevertheless mild in 9 out of 10 cases.
The adrenal gland consists of two distinct zones:
→ The first is the corticosurrenal zone which secretes different hormones: glucocorticoids, hormones of which cortisol is part which acts essentially on blood sugar (blood sugar level); the mineralocorticoids represented by aldosterone which intervenes on the kidney for the balance of the quantity of sodium and potassium in the body; and part of the androgens, hormones of the development of male sexual characteristics.
→ The other area is the medullosurrenal which secretes adrenaline and noradrenaline, which act on the rhythm of the heart, contraction or dilation of blood vessels and increase blood pressure.
“Among the well -identified causes, there are: genetic causes which are frequent in pheochromocytomas where they represent 30 to 40% of cases. In corticosurrenalomas, genetic causes (in the hereditary sense of the term) are found especially in children, much more rarely in adults (less than 5%). Molecular anomalies limited to tumor cells can also be identified in adult “, Indicates Pr Jérôme Bertherat.
Symptoms of adrenal cancer will therefore depend on the affected area. In case of corticosurrenaloma, the signs will be represented by:
- Cushing syndrome (which can have multiple causes but rarely adrenal cancer) in relation to an increase in the secretion of cortisol, with predominant android obesity on the abdomen, hypertension, appearance of stretch marks on the abdomen, decrease in muscle mass …
- A diabetes.
- Hyperandrogenism, by excess of androgens leading to an increase in hair, and masculinization in women.
- Hypokalemia (dropping potassium) which can lead the patient to drink a lot of water or to present muscle or heart problems.
In the event of a clever pheochromocytoma, the symptoms will be in the typical form: brutal discomforts which frequently associate headache, headache, palpitations, sweats and especially brutal pushes of very severe blood pressure. “5% of people have a ball in the adrenal or next to it. These cancers can be discovered by exploring symptoms but also simply in a fortuitous way, on a medical imaging examination for another disease: this is called an incidentaloma”, comments the endocrinologist.
- Stage 1 and 2: Cancer is located in the adrenal.
- Stadium 3: Regional invasion.
- Stage 4: Metastases.
“There are two classification systems between corticosurrenalomas and pheochromocytomas. The initial stage is purely located in the adrenal. If we diagnose the disease at this stage and that we can completely operate, we can obtain healing. At stage 3, the invasion is either regional or there are remote metastases, it depends on tumors. For tumors. Corticosurrenalomas, it is above all the liver and the lungs that are affected while in pheochromocytomas, it is more often the bone and possibly the liver and lung in a second step “, details the specialist. “For pheochromocytoma, the diagnosis of malignancy is sometimes difficult to do as long as there are no metastases”, Observes Pr Jérôme Bertherat.
In front of signs evocative of the adrenal tumor, a blood test with dosage of the different hormones is necessary to highlight the excess of secretion. Subsequently, an imagery of the adrenals, generally a scanner, often associated with an MRI, authorizes the visualization of the tumor. Scintigraphy is also possible. In the event of a suspicion of cancer tumor, an extension assessment will be practiced to seek the migration of cancer cells to other organs, which, in the presence of metastases, will sign the cancer character of the tumor.
As with all cancer tumors, the treatment will be adapted according to the evolution of the tumor, its size, the general condition of the patient and the results of the extension assessment. “First -line treatment when the tumor is not too metastatic is surgery, by a team specializing in the adrenal tumor”specifies the endocrinologist. It consists in removing the entire tumor, the surrounding tissues likely to be carriers of cancer cells and the nearby nodes if they are affected by cancer. “If the tumor recurrences or there are distance metastases that one cannot operate, one can discuss on a case -by -case case of medical treatments: mitotane for corticosurrenaloma and targeted therapy (temodal, kinase inhibitors) for the malignant pheochromocytoma. Cytotoxic in these tumors. he continues. Radiation therapy is less frequent in this context. Control of hormonal hypersecretion and its symptoms is also part of care.
Life expectancy varies depending on whether it is a corticosurrenaloma or a clever pheochromocytoma.
→ Corticosurrenaloma: “If we get a complete excision, life expectancy at 5 years is more than 80%. On the other hand, in metastatic stages, life expectancy does not exceed 30% at 5 years“, NOSU answers Pr Jérôme Bertherat.
→ Pheochromocytoma: cancer of this endocrine gland has the particularity of developing very slowly. Life expectancy is therefore more than 80% at 5 years. “However, this does not mean that healing is proven, patients can be metastatic and sometimes progress over more than 15 to 20 years”nuance the endocrinologist.
Thank you to Pr Jérôme Bertherat, head of the endocrinology department of Cochin Hospital and coordinator of the national reference network for rare cancers of the Endocan-Comete Surrenal.
