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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Oncology

Symptoms and Emergencies in Adrenal Cancer

At a Glance

Adrenal cancer can cause slow abdominal fullness, weight or hormone-related changes, but sudden severe headache, a racing heart, heavy sweating, very high blood pressure, profound weakness, confusion, dangerously low blood sugar, or severe abdominal pain require immediate emergency help.

Adrenal gland cancers can be “functional,” meaning they produce excessive amounts of hormones, or “non-functional,” meaning they do not [1]. Because these hormones control everything from your blood pressure to your blood sugar, an imbalance can cause a wide range of symptoms. While many symptoms develop slowly, some can become life-threatening emergencies very quickly.

Routine Symptoms and “Mass Effect”

Routine symptoms are those that are uncomfortable or concerning but generally develop over weeks or months. These symptoms are usually the first sign that something is wrong.

Symptoms of “Mass Effect”

As a tumor grows, it may press on nearby organs like the kidneys, stomach, or liver. This is called mass effect [1]. You might experience:

  • A dull ache or “fullness” in your abdomen or flank (the area between your ribs and hip) [1].
  • Feeling full quickly after eating only a small amount of food [1].
  • Unexplained weight loss or loss of appetite [2].

Hormone-Related Symptoms

The symptoms you experience depend on which hormone the tumor is overproducing:

  • Cortisol (Cushing’s Syndrome): Common in Adrenocortical Carcinoma (ACC), this can cause a “moon face” (rounding of the face), a fatty hump between the shoulders, purple stretch marks, and muscle weakness in the thighs and shoulders [3][4].
  • Androgens (Male Sex Hormones): In women, this may cause excess facial hair growth, a deepening voice, or irregular periods. In men, it may cause few symptoms or an enlarged chest [5].
  • Catecholamines (Adrenaline): Typical of Pheochromocytoma (PPGL), these can cause “spells” of high blood pressure, a racing heart (tachycardia), and anxiety [6][7].

Emergency Warning Signs: When to Call Emergency Services

Some complications of adrenal cancer require immediate medical intervention. Do not drive yourself to the ER. Call local emergency services immediately if you experience any of the following.

1. Hypertensive Crisis (Pheochromocytoma Crisis)

In people with catecholamine-secreting PPGL, the tumor can suddenly release a massive amount of adrenaline into the bloodstream. This can be triggered by certain medications (like anesthesia), trauma, or even pressing on the tumor [8][9].

  • Signs: A sudden, severe headache; a “pounding” or racing heart; heavy sweating; and extremely high blood pressure [6].
  • Danger: If not treated, this can lead to a stroke, heart attack, or heart failure [10][11].
  • Critical Medication Warning: Do not start, stop, or change a beta-blocker medication without urgent clinician direction. In suspected PPGL, beta-blockade must not be initiated before adequate alpha-blockade has been established, as doing so can cause blood pressure to skyrocket dangerously [12].

2. Adrenal Crisis (Adrenal Insufficiency)

This occurs when the adrenal glands cannot produce enough cortisol to meet the body’s needs. This is common if you are taking mitotane, if the cancer has spread to both adrenal glands, or if you have had surgery to remove them [2][13].

  • Signs: Sudden, profound weakness; severe vomiting or diarrhea; confusion; or a dangerous drop in blood pressure (shock) [2][14].
  • Action: This is treated with immediate injections of hydrocortisone and IV fluids [15][16]. If you have an emergency kit and are trained, use it while waiting for emergency services.

3. Severe Cortisol Excess

When ACC produces extreme amounts of cortisol, it becomes an endocrine emergency [3].

  • Signs: Severe confusion or psychosis, dangerously low potassium levels (which can cause heart rhythm problems), or sudden, severe swelling in the legs [3][17].
  • Danger: This increases the risk of life-threatening infections and blood clots in the lungs (pulmonary embolism) [18][19].

4. Severe Hypoglycemia (Low Blood Sugar)

Some large ACC tumors produce proteins that act like insulin, causing blood sugar to drop to dangerous levels [20].

  • Signs: Sudden shakiness, sweating, confusion, seizures, or loss of consciousness [20][21].
  • Action: If you are awake and can swallow safely, eat or drink fast-acting sugar. Do NOT give food or drink to someone who is unconscious or having a seizure. Call emergency services and use prescribed emergency glucagon if available.

5. Tumor Rupture or Hemorrhage

Rarely, an adrenal tumor can bleed into itself or rupture.

  • Signs: Sudden, “stabbing” or tearing pain in the abdomen or back; dizziness or fainting; and becoming very pale [22][23].

Symptoms That Often Warrant Contacting Your Team Soon

While the following symptoms generally do not require an immediate 911 call, they should be reported to your oncology team soon, according to your individualized plan:

  • Gradual weight gain or slow changes in your physical appearance (like new stretch marks) [3].
  • Worsening fatigue or a general feeling of being “unwell” [2].
  • Changes in your blood pressure that fall outside the target ranges set by your doctor [7].
  • New or worsening indigestion or abdominal discomfort [1].

Always trust your instincts. If a symptom feels “different,” is worsening rapidly, or you are unsure, it is better to be evaluated by a medical professional immediately.

Common questions in this guide

Which adrenal cancer symptoms mean I should call emergency services?
Call local emergency services for a sudden severe headache with a pounding or racing heart, heavy sweating, and extremely high blood pressure; profound weakness, severe vomiting or diarrhea, confusion, or very low blood pressure; a seizure or loss of consciousness; or sudden severe abdominal or back pain with fainting. These symptoms can reflect dangerous hormone-related complications or bleeding. Do not drive yourself if you may be having one of these emergencies.
What are the usual symptoms of adrenal cancer?
Symptoms may include a dull ache or fullness in the abdomen or flank, getting full quickly, unexplained weight loss, or loss of appetite. Tumors that produce hormones can also cause muscle weakness, purple stretch marks, excess facial hair, voice changes, irregular periods, a racing heartbeat, anxiety, or episodes of high blood pressure. Symptoms may develop slowly, so report new or worsening changes to your oncology team.
What does an adrenal crisis feel like, and who may be at risk?
An adrenal crisis can cause sudden profound weakness, severe vomiting or diarrhea, confusion, and a dangerous fall in blood pressure. Risk is higher for people taking mitotane, those whose cancer affects both adrenal glands, or those who have had surgery to remove the adrenal glands. This is an emergency treated with hydrocortisone and intravenous fluids, so follow your emergency-kit plan and call emergency services.
What are the warning signs of a pheochromocytoma crisis?
A pheochromocytoma crisis can begin with a sudden severe headache, pounding or racing heart, heavy sweating, and extremely high blood pressure. It can lead to a stroke, heart attack, or heart failure, so call emergency services immediately. Do not start, stop, or change a beta-blocker without urgent clinician direction; when pheochromocytoma is suspected, beta-blockade must follow adequate alpha-blockade.
What should I do if adrenal cancer causes dangerously low blood sugar?
If you are awake and can swallow safely, eat or drink fast-acting sugar. Do not give food or drink to someone who is unconscious or having a seizure; call emergency services and use prescribed emergency glucagon if it is available. Shakiness, sweating, confusion, seizures, or loss of consciousness require urgent attention.
Could sudden abdominal pain mean an adrenal tumor is bleeding or rupturing?
Rarely, an adrenal tumor can bleed or rupture, causing sudden stabbing or tearing pain in the abdomen or back, dizziness, fainting, or unusual paleness. Treat these symptoms as an emergency and call local emergency services rather than driving yourself.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What are the specific 'red flag' symptoms I should look for that mean I need to call emergency services immediately?
  2. 2.What is my 'sick day rule' plan for adjusting my medications if I get a fever or a serious infection?
  3. 3.If I experience sudden, severe abdominal pain, how can we tell if it is a tumor rupture or hemorrhage?
  4. 4.Since I am taking mitotane or other treatments, am I at risk for an adrenal crisis, and should I carry an emergency injection kit?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (23)
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    European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors

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    Adrenal crisis: prevention and management in adult patients.

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This page explains symptoms and emergency warning signs of adrenal cancer for informational purposes only and does not constitute medical advice. Seek emergency care for severe or rapidly worsening symptoms, and follow your oncology team's individualized plan.

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