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Adrenal Cancer Symptoms: Hormone Changes, Early Warning Signs, and When to Get Checked
Adrenal cancer is unusual among cancers. Most of what a person notices does not come from the lump itself. It comes from the hormones the lump makes. That is why adrenal cancer symptoms so often look like something else entirely, and why so many people spend a long time being treated for the wrong thing. This guide walks through the common symptoms, the ones that show up less often, and the changes that can appear if the cancer has spread. It also covers pheochromocytoma separately, because that is a different adrenal cancer with a very different symptom pattern. Nothing here is a diagnosis. Use it to decide whether it is time to ask for a hormone workup, and bring your questions to your own care team.
What Are the Signs and Symptoms of Adrenal Cancer?
Here is the single most important idea in this guide. Your adrenal glands are two small triangular glands, one sitting on top of each kidney. According to the National Cancer Institute, the outer layer of each gland, called the adrenal cortex, makes hormones that balance the water and salt in your body, help keep your blood pressure normal, help control how your body uses protein, fat, and carbohydrates, and drive masculine or feminine physical traits. When a cancer grows in that outer layer, it can keep making those hormones, only in far larger amounts and with no off switch. The flood of hormones is what changes your body. The tumor itself may be completely silent.
This means adrenal cancer causes symptoms by two separate routes. The first route is hormone excess, sometimes called a functioning tumor. The second route is mass effect, which simply means a growth is taking up space and pressing on things around it. StatPearls, a peer-reviewed clinical reference, reports that functioning tumors account for roughly 40% to 60% of adrenocortical carcinoma cases, and the American Cancer Society puts it at about half. The remaining cases are found a different way: because of pain, because of a lump, because of fullness in the belly, or because a scan done for a completely unrelated reason happened to show a mass.
Both routes are easy to miss, and the hormone route is the worst offender. High cortisol causes weight gain, tiredness, high blood pressure, high blood sugar, and mood changes. Every one of those is extremely common on its own and has dozens of ordinary explanations. The National Institute of Diabetes and Digestive and Kidney Diseases says this plainly: Cushing syndrome, the condition caused by too much cortisol, can be hard to diagnose because symptoms such as fatigue and weight gain can have many different causes, and it may be mistaken for other conditions with many of the same signs, such as polycystic ovary syndrome (PCOS), more recently referred to as polycystic metabolic ovary syndrome (PMOS). So the delay is not anyone being careless. It is built into how the disease presents. The cost of that delay is real, though. StatPearls notes that more than half of people with adrenocortical carcinoma already have locally advanced or metastatic disease, meaning stage III or stage IV, by the time they are diagnosed.
If you have spent months or years being told that your weight was the problem, that your blood pressure just needed another pill, that your missed periods and new facial hair were polycystic ovary syndrome, or that everything you were feeling was menopause, you are not imagining the pattern, and you are not alone in it. Many patients describe exactly that experience. These hormone changes alter your face, your body shape, your hair, your voice, your mood, and your sleep, all at once. Your observations are data. Bring them, in writing if it helps, and ask specifically whether your hormone levels have ever been measured.
One more piece of vocabulary, because it confuses almost everyone. In this guide, "adrenal cancer" means adrenocortical carcinoma, a cancer that starts in the adrenal cortex. That is not the same thing as cancer that started somewhere else and spread to an adrenal gland. Cancer Research UK is direct about this: secondary cancer in the adrenal glands is more common than cancer that starts in them, and if kidney cancer spreads to an adrenal gland, it is treated as kidney cancer, not as adrenal gland cancer. It is also not the same thing as a benign adrenal tumor. If a CT scan just turned up an adrenal mass and you found your way here while frightened, please know that most adrenal masses are benign adenomas, often called an adrenal incidentaloma because they are found by accident. Cancer Research UK notes that adenomas frequently need no treatment at all. Our guide on how adrenal cancer is diagnosed explains the workup that sorts one from the other.
So here is a practical rule you can hold onto. Hormone symptoms that arrive together, and that keep progressing, deserve a hormone workup, not another round of lifestyle advice. That means blood and urine tests for cortisol, aldosterone, potassium, and sex hormones, and imaging if those tests are abnormal. The same goes for belly or side pain that will not settle, or an adrenal mass someone mentioned on a scan and then moved past. Adrenal cancer is genuinely rare, so the odds are strongly in your favor that testing will find something else or nothing at all. That reassurance is worth having.
A Note on Pheochromocytoma, Which Feels Completely Different
Pheochromocytoma is a different adrenal cancer and works differently. It starts in the inner part of the gland, the adrenal medulla, rather than in the cortex, and the National Cancer Institute keeps it in a separate summary from adrenocortical carcinoma for that reason. Instead of a slow buildup of cortisol or sex hormones, it releases surges of adrenaline and noradrenaline, the fight-or-flight hormones. The result is not gradual weight gain and stretch marks. It is sudden episodes of pounding heartbeat, headache, and drenching sweat. Because the pattern is so different, it gets its own labeled section further down this guide.
Source: National Cancer Institute - Credit Terese Winslow
What Are the Most Common Symptoms of Adrenal Cancer?
The most useful way to organize adrenal cancer symptoms is by which hormone the tumor is making, because that is what decides what you notice. The National Cancer Institute lists four hormones that a functioning adrenocortical tumor can overproduce: cortisol, aldosterone, testosterone, and estrogen. Some tumors make one. Some make more than one. StatPearls reports that combined glucocorticoid and androgen excess, meaning too much cortisol and too much male-type hormone at the same time, occurs in about 50% of functioning tumors, so mixed pictures are normal rather than strange.
Cortisol excess is by far the most common pattern, and it produces a cluster of changes doctors call Cushing syndrome.
Cortisol excess, body shape: Weight gain concentrated in the face, neck, and trunk while the arms and legs stay thin or get thinner. The National Cancer Institute lists exactly this combination. It happens because cortisol moves fat toward the center of the body while breaking down muscle in the limbs.
Cortisol excess, face and neck: A rounded, full, sometimes reddened face, often called a moon face, plus a pad of fat that builds up at the base of the neck and between the shoulders. Cancer Research UK describes this as a fatty hump at the top of the back.
Cortisol excess, skin: Wide stretch marks that are purple or pink rather than pale, most often across the belly, along with easy bruising and skin that becomes thin and fragile. StatPearls explains why: cortisol breaks down protein, and skin, blood vessel walls, and healing tissue are all built from protein.
Cortisol excess, muscles: Weakness and loss of muscle bulk, worst in the shoulders, hips, and thighs. StatPearls describes patients having trouble combing their hair or rising from a sitting position. This is one of the more specific clues, because ordinary tiredness does not usually do that.
Cortisol excess, blood sugar and blood pressure: High blood sugar that often tips over into new type 2 diabetes, and high blood pressure. Both are on the National Cancer Institute's list and the American Cancer Society's list.
Cortisol excess, mood and sleep: Depression, mood swings, irritability, anxiety, and trouble concentrating. Cortisol normally follows a daily rhythm and drops once you fall asleep. In Cushing syndrome, as the NIDDK explains, it does not drop, so sleep is often broken and unrefreshing.
Cortisol excess, bones and healing: Bone thinning, called osteoporosis, which raises the risk of fractures, plus slow wound healing and more frequent infections, including stubborn fungal and bacterial infections. StatPearls lists all of these.
Aldosterone excess: is a different and more focused picture. Aldosterone controls salt, water, and potassium, so too much of it shows up mostly as a blood pressure and electrolyte problem.
High blood pressure that is hard to control even on multiple medicines
Low potassium on a blood test
Muscle cramps and weakness
Needing to urinate frequently and feeling constantly thirsty.
Note: the American Cancer Society points out that benign adrenal adenomas often make aldosterone, while adrenal cancers rarely do, so this pattern more often leads to a benign diagnosis.
Sex hormone excess is the pattern that most often makes someone finally get tested, because the changes are visible and hard to explain away. What you notice depends on which hormone is in excess and on your own baseline.
Androgen excess in women: New or coarse hair on the face, chest, back, and abdomen, acne, a deepening voice, periods that become irregular or stop, hair thinning or a receding hairline at the temples in a male pattern, and more muscle definition than usual. The National Cancer Institute and the American Cancer Society both describe this combination, and StatPearls adds enlargement of the clitoris in more pronounced cases.
Androgen excess in men: Usually no noticeable symptoms at all, because the body is already accustomed to testosterone. The National Cancer Institute says this directly, and StatPearls notes that men with isolated androgen excess frequently go undiagnosed for that reason.
Estrogen excess in men: Growth of breast tissue, which the American Cancer Society notes can be tender, along with lower sex drive and erectile difficulty. StatPearls adds shrinking of the testicles. Because these changes are the opposite of what the body expects, they tend to be noticed sooner.
Estrogen excess in women: Irregular periods before menopause, vaginal bleeding after menopause, and weight gain, according to the National Cancer Institute. Bleeding after menopause always deserves evaluation, whatever the cause turns out to be.
The second route to symptoms is mass effect, and it is what usually brings in people whose tumors make no extra hormones at all. StatPearls reports that the average adrenocortical carcinoma is already 10 to 13 centimeters across at diagnosis, with nonfunctioning tumors generally larger than functioning ones, so there is real bulk pressing on the stomach, liver, kidney, and diaphragm.
Mass effect: Pain in the belly, side, or back near the tumor, a persistent feeling of fullness or pressure in the abdomen, filling up quickly after only a few bites of food, and sometimes a firm lump your doctor can feel during an abdominal exam. The National Cancer Institute lists a lump in the abdomen, pain in the abdomen or back, and a feeling of fullness as the leading signs. The American Cancer Society lists pain near the tumor, abdominal fullness, and trouble eating because of filling up quickly.
Any single item on these lists is far more likely to have an ordinary cause than to be adrenal cancer. What raises concern is the combination and the trajectory: several hormone changes appearing over the same stretch of months, getting more pronounced rather than settling, and not responding to treatment aimed at the obvious diagnosis. If you want help asking for the right tests, our list of questions to ask about adrenal cancer can be printed and taken with you. It is entirely reasonable to say, "I would like my cortisol and my potassium checked, because several things have changed at once."
What Are the Less Common Symptoms of Adrenal Cancer?
Some symptoms of adrenal cancer are less common but worth knowing, because they are the ones people least expect. General, whole-body symptoms head the list. StatPearls reports that adrenocortical carcinoma can cause fatigue, unintended weight loss, and fever as systemic effects of the disease itself, and Cancer Research UK lists tiredness, weight loss, and feeling or being sick among the symptoms of tumors that do not make hormones. Night sweats belong in the same general group; the American Cancer Society lists fever or night sweats among the broad signs that any cancer can produce. None of these point to the adrenal gland specifically, which is precisely why they get filed under stress or a virus.
Blood clots deserve their own mention. StatPearls describes hypercoagulable states, meaning blood that clots too easily, as an association of adrenocortical carcinoma, and notes that the rate of venous thromboembolism is elevated in these patients. In plain terms, that means a higher chance of a clot forming in a leg vein or traveling to the lungs. The NIDDK also lists blood clots in the legs and lungs as a complication of Cushing syndrome in general. A newly swollen, warm, painful calf, or sudden breathlessness with chest pain, is an urgent problem no matter what is causing it, so seek care the same day rather than waiting for a routine appointment.
Swelling in one or both legs can happen for a related but separate reason. A large adrenal tumor sits close to the inferior vena cava, the major vein that carries blood from the lower body back to the heart. StatPearls lists inferior vena cava thrombosis from tumor compression or invasion as a recognized complication, and includes checking for lower leg swelling as part of the physical exam. When that big vein is squeezed, narrowed, or blocked, fluid backs up, and the legs feel heavy and tight. This is worth reporting promptly, because it changes what imaging and what surgical planning your team will want.
Low blood sugar is uncommon but can occur. StatPearls describes a paraneoplastic syndrome in adrenocortical carcinoma in which the tumor produces a substance called IGF-2, which behaves somewhat like insulin and drives blood sugar down. "Paraneoplastic" just means a symptom caused by a substance the tumor releases rather than by the tumor's size or location. If you or your child have had unexplained episodes of shakiness, confusion, sweating, or faintness that improve with eating, mention it, because that pattern is a specific clue rather than a vague one.
Back pain, bone pain, and nausea round out the list. The National Cancer Institute includes pain in the abdomen or back among the core signs of adrenocortical carcinoma, and StatPearls lists back pain and bone pain among the findings in cortisol excess, which makes sense given how much bone thinning severe hypercortisolism causes. And it bears repeating that some adrenal cancers cause nothing at all for a long time. Nonfunctioning tumors make no extra hormones, so there is nothing to notice until they are big enough to press on something or until they turn up on a scan ordered for an unrelated reason. StatPearls notes that the share of adrenal masses discovered incidentally has risen substantially as imaging has become more common.
Pheochromocytoma Symptoms, a Different Disease With a Different Pattern
Pheochromocytoma is a different adrenal cancer from adrenocortical carcinoma, and nothing in the section above describes it well. It starts in the adrenal medulla, the inner core of the gland, which makes adrenaline and noradrenaline rather than cortisol and sex hormones. Paraganglioma is the closely related tumor that forms in the same type of cell but outside the adrenal gland, in the head, neck, chest, abdomen, or pelvis. The two are usually discussed together as PPGL. Diagnosis, genetics, treatment, and outlook all differ from adrenocortical carcinoma, so if this is your diagnosis, look specifically for pheochromocytoma and paraganglioma information rather than general adrenal cancer information.
The symptoms come from surges of fight-or-flight hormones, and clinicians describe a classic triad. StatPearls states: the classic triad of symptoms consists of episodic headaches, sweating, and a racing heart. The National Cancer Institute's own symptom list matches, naming high blood pressure, headache, heavy sweating for no known reason, a strong, fast, or irregular heartbeat, being shaky, and being extremely pale. The National Cancer Institute adds that the most common sign is high blood pressure that may be hard to control, and that very high blood pressure can cause serious problems including irregular heartbeat, heart attack, and stroke.
The other defining feature is that symptoms are random rather than staying constant. The National Organization for Rare Disorders describes chronic episodes of high blood pressure that often bring headaches, palpitations, and profuse sweating, and notes that blood pressure may be always present or may come and go, with episodes ranging from several times a day to a couple of times a month. Cancer Research UK describes these attacks as usually lasting under 15 minutes, sometimes up to an hour, followed by feeling very weak, and becoming more frequent over time. Alongside the physical symptoms, Cancer Research UK lists anxiety or panic attacks, looking very pale, and feeling weak, and the National Organization for Rare Disorders describes attacks of anxiety or apprehension. Many patients describe these spells as feeling like sudden dread arriving out of nowhere.
Certain things can trigger symptoms, which is one of the most practical facts to know. The National Cancer Institute lists hard physical activity, physical injury, or a lot of emotional stress, childbirth, going under anesthesia, surgery including the operation to remove the tumor itself, and eating foods high in tyramine such as red wine, chocolate, and cheese. This is why anyone with a suspected pheochromocytoma needs specific medication to block the effects of these hormones before any operation or procedure. Tell every clinician you see, including your dentist and anesthesiologist, if pheochromocytoma is even being considered.
Two more things are worth knowing. First, most pheochromocytomas are not cancerous. Cancer Research UK reports that only about 10 in 100 spread to other parts of the body such as the lymph nodes, bones, or liver, and the National Organization for Rare Disorders says approximately 85% are noncancerous. Second, some are found before they cause any symptoms at all, either on a scan done for another reason or through surveillance in someone known to carry a high-risk gene. Because genetics matter so much here, our guide on risk factors for adrenal cancer covers PPGL genetic testing in its own section.
What Are the Symptoms of Advanced (Metastatic) Adrenal Cancer?
Metastatic means the cancer has spread beyond where it started. For adrenocortical carcinoma, this is unfortunately common at diagnosis. StatPearls reports that distant metastases develop in over 50% of patients, and that the most common sites are the lungs, involved in 40% to 80% of metastatic cases. The liver, in 40% to 90%, and the bones in 5% to 20%. Lymph nodes near the adrenal gland can also be involved, and node-positive disease is significant enough that the modified ENSAT staging system reclassifies it from stage III to stage IV. You can read more about what stage means in our guide on adrenal cancer stages.
The first thing many people notice as the disease advances is that their hormone symptoms get worse, not that they feel a new lump. A bigger tumor makes more hormone. Cortisol excess that was manageable becomes severe: blood sugar that will not come down, blood pressure that keeps climbing, muscle wasting that makes stairs difficult, bones that fracture easily, and mood or thinking changes that are hard to live with. StatPearls describes uncontrolled hypercortisolism as the most serious functional complication, occurring in 50% to 80% of hormone-secreting tumors, and causing severe diabetes, profound muscle weakness progressing to myopathy, severe osteoporosis with fractures, serious psychiatric problems, and dangerously high blood pressure with low potassium. Very high cortisol also suppresses the immune system, which is why infections become more frequent and more serious, and why any fever deserves a prompt call rather than a wait-and-see approach.
Where the cancer has spread determines the rest. StatPearls notes that metastatic disease may produce bone pain, respiratory symptoms from lung involvement, and jaundice from liver involvement. Liver spread can cause an ache or a heavy fullness under the right ribs, poor appetite, and jaundice, which is a yellow tint to the skin and to the whites of the eyes. Lung spread can cause a cough that does not clear, chest discomfort, or breathlessness that is new for you. Bone spread causes a deep, focused ache that often feels worse at night and, because cortisol has already weakened the bone, can lead to a fracture from a minor stumble or no injury at all.
Spread to the brain is not among the sites StatPearls lists as common for adrenocortical carcinoma, but it can happen with many advanced cancers. Symptoms would include new or changing headaches, especially ones worse in the morning, new nausea or vomiting, vision changes, weakness or numbness on one side, trouble with speech or balance, confusion, or a seizure. Any of those needs urgent evaluation. Alongside all of this, general symptoms tend to build: marked fatigue that rest does not fix, appetite loss, and weight loss, which StatPearls lists among the systemic effects of the disease.
The part that matters most is that hormone symptoms can be treated even when the cancer itself cannot be cured, and doing so meaningfully changes how a person feels day to day. StatPearls is explicit that treatment of advanced adrenocortical carcinoma must be considered palliative, and that this includes pain control, prevention of fractures from bone metastases, and adequate control of hormonal symptoms. It goes further: because elevated cortisol is itself an adverse prognostic factor, every attempt should be made to normalize hormone levels, as this affects both survival and quality of life. There are specific medicines for this, including drugs that block hormone production such as levoketoconazole and metyrapone, a drug that blocks cortisol's effect called mifepristone, medicines such as spironolactone and eplerenone for fluid retention and blood pressure, and medicines for breast tissue growth in men. Mitotane, the only drug approved specifically for advanced adrenocortical carcinoma, also lowers hormone production.
The practical takeaway is to name every symptom out loud, including the ones that feel cosmetic or embarrassing, because most of them are treatable targets rather than things you simply have to endure. Ask your team directly whether an endocrinologist is involved in your care, since hormone control is a specialist skill. Ask about clinical trials for adrenal cancer, which are especially important in a cancer this rare, and about getting to a high-volume center with an adrenal specialist. Our guides on adrenal cancer treatment and adrenal cancer survival rates explain the options and what the numbers do and do not mean. Every decision about your care belongs to you and your own care team, and practical and emotional help is available at any stage through our adrenal cancer support guide.