Adrenal nodules can produce hormones
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.