Adrenal Carcinoma Differential Diagnoses

Updated: Dec 06, 2022
  • Author: Bagi RP Jana, MD, MBA, MHA, FACP; Chief Editor: Lawrence T Kim, MD, FACS, FACE  more...
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Diagnostic Considerations

In children, consider the following:

  • Neuroblastoma (particularly in neonates)
  • Nephroblastoma
  • Congenital adrenal hyperplasia
  • Metastatic adrenal deposits
  • Ganglioneuroma/ganglioneuroblastoma

In adults, consider the following:

  • Pheochromocytoma
  • Massive macronodular adrenal hyperplasia
  • Functional ovarian tumors (although easily distinguishable with good imaging modalities such as abdominal computed tomography [CT] or magnetic resonance imaging [MRI] scans)
  • Adrenal myelolipoma
  • Adrenal angiomyolipomas
  • Metastatic deposits
  • Adrenal hamartoma
  • Adrenal teratoma
  • Plexiform neurofibromas
  • Adrenal amyloidosis
  • Various adrenal granulomas (eg, tuberculosis, blastomycosis, histoplasmosis)
  • Various soft-tissue sarcomas

Use a higher index of suspicion for children with adrenal masses; these may be malignant even when smaller than 4-5 cm in diameter. In children younger than five years, neuroblastoma and Wilms tumor are the most likely malignant diagnoses. In older patients, lymphoma, germ cell tumors, sarcoma, undifferentiated tumors, and neuroblastoma are possible.

Recognition of primary adrenal lymphoma, as distinct from adrenocortical carcinoma (AC), is important not only because primary adrenal lymphoma is rare (< 100 well-documented cases in the medical literature), but also because it may be associated with a better prognosis than AC, owing to the potential roles for standard lymphoma treatment using multiagent chemotherapy and radiotherapy.

When patients present with adrenocortical hormone overproduction, the differential diagnosis usually includes carcinoma, adenoma, and hypothalamic pituitary error.

For patients who present with only a palpable mass, the differential diagnosis varies with age, and the range is broad.

Differential Diagnoses