Adrenal nod­ules can pro­duce hor­mones

Cape Breton Post - - IN MEMORIAM/PUZZLES/ADVICE - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslett

DEAR DR. ROACH: My hus­band's re­cent CT scan of his stom­ach and di­ges­tive sys­tem with and with­out con­trast re­vealed that he has nod­ules on both adrenal glands. It was sug­gested that he un­dergo a blood test to de­ter­mine if the nod­ules are pro­duc­ing hor­mones.

For the past 21 months, he has been ex­pe­ri­enc­ing high blood pres­sure, nau­sea, di­ar­rhea, anx­i­ety and ab­dom­i­nal pain. Could this be the source of his prob­lems? If so, what course of ac­tion would you rec­om­mend? — J.S.

AN­SWER: The adrenal gland is re­spon­si­ble for the pro­duc­tion of sev­eral im­por­tant hor­mones es­sen­tial for reg­u­lat­ing body func­tion. Tu­mors, or nod­ules, of the adrenal glands are com­mon. They can be cat­e­go­rized into those that make hor­mones and those that don't, and also by whether the tu­mors are be­nign or ma­lig­nant. The most com­mon, by far, are be­nign, non­func­tion­ing tu­mors. These usu­ally are dis­cov­ered on an ul­tra­sound or a CT scan ob­tained for some other rea­son. They go by the whim­si­cal name "adrenal in­ci­den­talo­mas." More than 4 per­cent of peo­ple have an adrenal mass, and 85 per­cent of these are non­func­tional.

How­ever, the symp­toms your hus­band has been hav­ing raise a con­cern that he may have a hor­mone-pro­duc­ing tu­mor. There are four types of hor­mones com­monly pro­duced by adrenal tu­mors: cor­ti­sone, al­dos­terone, sex hor­mones (es­tro­gen or an­dro­gens) and cat­e­cholamines (epi- nephrine and nor­ep­i­neph­rine).

A cor­ti­sone-pro­duc­ing adrenal tu­mor causes Cush­ing's syn­drome, usu­ally caus­ing weight gain, es­pe­cially in the ab­domen, skin changes (in­clud­ing striae, or "stretch marks"), high blood pres­sure and a pre­dis­po­si­tion to di­a­betes. Anx­i­ety and ab­dom­i­nal pain are un­com­mon.

Al­dos­terone raises blood pres­sure, so a per­son with a func­tion­ing adrenal tu­mor mak­ing al­dos­terone usu­ally has high blood pres­sure, but the other symp­toms you men­tion for your hus­band are not com­mon for this.

Although your hus­band's symp­toms are not spe­cific for any one con­di­tion, the com­bi­na­tion of his symp­toms and adrenal nod­ules con­cern me. I agree com­pletely with the rec­om­men­da­tion to look for ex­cess amounts of hor­mone in the blood. This of­ten can be achieved with a sim­ple blood test; how­ever, oc­ca­sion­ally a catheter is placed in the adrenal vein to sam­ple blood com­ing from the gland (and its nod­ule) di­rectly. By com­par­ing one side against the other, the doc­tors can de­ter­mine which side might be pro­duc­ing ex­cess hor­mone.

An en­docri­nol­o­gist is the ex- pert most likely to have fa­mil­iar­ity with these con­di­tions.

DEAR DR. ROACH: For the past cou­ple of years, my wife has been get­ting pe­ri­odic CT scans be­cause of her ovar­ian can­cer. The first time she had a scan, she was given a white, chalky liq­uid con­tain­ing the marker. It made her sick to her stom­ach. The next time she had a CT scan, she was of­fered a soda with the marker to drink. She was able to drink that with no nau­sea.

Does she get as good a scan with the soda as she would get from drink­ing the white chalky stuff? — A.H.

AN­SWER: Both bar­ium-based con­trast (the chalky stuff) and io­hexol-based or gas­tro­graf­fin-based con­trast (usu­ally put into fla­vored soda or lemon­ade) pro­vide ex­cel­lent-qual­ity im­ages. Some peo­ple have dif­fi­culty with the taste, and all can cause nau­sea, vom­it­ing and di­ar­rhea. Bar­ium can cause con­sti­pa­tion. Some­times the type of scan re­quires one type ver­sus the other, but oth­er­wise the de­ci­sion can be made based on pa­tient pref­er­ence.

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