As part of the Rogel Cancer Center, our Endocrine Cancer Program brings experts in related fields together to provide coordinated, exceptional patient care to those diagnosed with adrenocortical carcinoma (adrenal cancer). Patients benefit from the experience and expertise of many physicians, not just one.

Our multidisciplinary tumor board meets on a regular basis to discuss every patient who comes through our doors. A room full of specialists sit together to talk through the best treatment options, including clinical trials, for each individual. Patients get the benefit of several expert opinions.

Services include:

• Multidisciplinary team with one of the most active adrenal cancer research programs in the world
• See more than 200 adrenal patients per year
• Recognition as an international center of excellence for treatment of adrenal cancer
• Availability of state-of-the-art genetic counseling
• Advanced diagnostics
  • Diagnosis and therapy of benign and malignant adrenal tumors, pheochromocytoma, paraganglioma and neuroendocrine tumors
  • Diagnosis and therapy of hormone excess syndromes due to adrenal adenoma, adrenal cancer, pherochromocytoma, paraganglioma or neuroendocrine tumors
  • Dedicated radiology and nuclear medicine imaging
• Specialized therapies
  • Stereotactic Body Radiation Therapy for adrenal metastasis
  • Dedicated adrenal and endocrine surgeons
• Innovative care models
  • Remote Second Opinion Program for adrenal cancer
  • Pathology Consultation
  • Therapy and surveillance of endocrine issues in cancer survivors

We offer diagnosis and treatment for those with adrenal tumors.  If you have been diagnosed, or suspect you have an adrenal tumor, patients, please call 734-647-8902.

Healthcare professionals, please contact our M-LINE service: 800-962-3555.  Our Endocrine Oncology Program also offers a consultation with one of our Pathology experts.  Please visit the M-Labs Consult page for more information.

Remote Second Opinion

U-M Health's Remote Second Opinion is available to those with adrenal cancer or are suspected to have adrenal cancer. With our Remote Second Opinion, you can obtain a medical consultation regarding your diagnosis and treatment plan by allowing our physicians to review your medical records and remotely interact with you and your local doctor. So, even if you can’t travel to Michigan for an appointment, you can still get an opinion from our medical specialists.  

Diagnosis of Conns Syndrome (primary hyperaldosteronism) is confirmed by having an elevated aldosterone level and decreased renin level with an aldosterone:renin ratio of at least 20:1. Diagnosis is inferred from laboratory work. Imaging is then obtained, if not already performed, and in most cases adrenal vein sampling (an interventional radiology procedure) is performed. Adrenal vein sampling identifies from which adrenal gland excess aldosterone is coming from. In some patients, both adrenal glands are producing too much aldosterone. These patients are treated with medications such as spironolactone, aldactone, or eplerenone as it is not desirable to remove both adrenal glands in most patients.

Patients with symptoms suspicious for adrenal cancer will undergo tests to determine the cause of these symptoms. The first step is a thorough medical history and physical exam to determine the extent of symptoms and their possible causes.

Evaluation for other adrenal tumors may include the following:

• Blood and urine tests will be done to evaluate levels of adrenal hormones. Remember that adenomas (benign tumors) may produce high levels of adrenal hormones. Therefore, high hormone levels do not always indicate an adrenal cancer. Some blood and urine tests may be done after you are given a steroid such as dexamethasone. The blood and urine tests after the medication will measure your bodies’ response to the steroid, indicating the presence of a hormone secreting tumor or other problem with the adrenal gland.
• Computed Tomography (CT)
  The CT scan can show small tumors as well as important blood vessels that the tumor might be growing into or around. A CT scan can look at surrounding organs for spread (metastasis) of the cancer into lymph nodes or other organs in the abdomen.
  
  A CT scan takes longer than a regular x-ray. You will lie still on a table while it is being done. Usually, you will need an IV placed for a dye injection just before the scan. You may also be asked to drink a contrast solution before the exam. This helps outline the intestine so it is not mistaken for tumors.
• Magnetic Resonance Imaging (MRI)
  The MRI scan uses magnets to make a picture of the inside of the body. MRIs produce very sharp, precise pictures of the area and can be helpful in distinguishing an adenoma from a cancer.
• Ultrasound of the abdomen:
  An ultrasound can identify a tumor or mass by using sound waves to make a picture of the inside of the abdomen. This is the fastest and cheapest test used; however it is the least accurate. It can be difficult to tell the difference between an adenoma and cancer with an ultrasound. An ultrasound may be used to guide the biopsy procedure as described above under CT scan.
• Positron emission tomography (PET)
  A PET scan involves the injection of radioactive sugar into a vein followed by a body scan that looks for areas taking up the sugar. Cancer cells take up sugar much faster than normal tissue, so cancerous areas can be located with this test. Research studies have shown the usefulness of PET scanning in identifying adrenal tumors. However, studies are still in progress to look at ways PET scanning can be used to tell the difference between adrenal cancers and benign adenomas and between primary adrenal cancers from metastatic tumors that started in other organs. One of these studies uses a substance called metomidate as the radioactive substance. Some studies suggest it can be helpful in distinguishing primary tumors from metastatic ones.
• Angiography
  The adrenal gland is situated near a number of important veins and arteries. Some studies may be necessary to evaluate the involvement of these blood vessels, such as whether the tumor is compressing or blocking them. These studies are referred to as selective angiography and adrenal venography.

Surgery is the treatment of choice if possible. In many cases, patients present after tumor has spread to other organs in the body or the tumor has invaded structures that cannot be removed and the tumor is considered inoperable. If patients are able to undergo surgery, it is extremely important that your surgery is performed by a surgeon experienced in the treatment of adrenal cancer (most surgeons see one adrenal cancer patient in a lifetime), as the covering of the tumor must not be penetrated during surgery and a wide margin of normal tissue around the tumor should be included to ensure complete resection and minimize the chance for local recurrence. At U-M Health, our endocrine surgeons often operate on patients with advanced adrenal cancer, including patients who have been told by other health care teams that their tumor is unresectable. Appropriate preoperative evaluation and planning is of the utmost importance in adrenal tumor patients to assure optimal outcome. 

Based on experience and research done at the Rogel Cancer Center, we generally do not recommend removing adrenal tumors (or any mass/nodule suspected of potentially being malignant) using a laparoscopic approach as it often leads to early recurrence in the abdominal cavity due to microscopic tumor spillage. Often, the entire tumor is not resected when the procedure is performed laparoscopically, and the "margins" (edges of the tissue removed) are positive for tumor cells. An open approach (through a larger incision along the rib cage or along the midline of the abdomen) allows the surgeon to remove a rim of normal (benign) tissue around the tumor more easily to help decrease rates of local recurrence and spread within the abdomen and has been found to improve survival in patients with adrenal cancers which have not already spread outside the adrenal gland.

Pheochromocytoma and Paraganglioma Treatment

Prior to surgery, it is extremely important that the blood pressure be well controlled using certain medications called alpha blockers, beta blockers, and on occasion calcium channel blockers. Alpha blockers (such as dibenzyline) should always be started before beta blockers (such as metoprolol, propranolol, or other medications in the same class) in order to prevent cardiac collapse. Medications to control the blood pressure and heart rate are increased until patients achieve blood pressure goals and also if they have symptoms of nasal stuffiness and slight dizziness upon initially standing. If these goals are not met prior to surgery, the blood pressure may become dangerously high during surgery as the tumor is manipulated and lead to heart attacks, strokes, and increased bleeding.