What Blood Tests and Hormone Tests are Needed for Adrenal Tumors?

After performing a very careful interview of the patient to see if they have any signs and symptoms of adrenal hormone excess, the next step is to perform laboratory testing to see if the adrenal tumor is overproducing any hormones. Knowing what hormone is being produced (if any), and how much is critically important. Unfortunately, testing for hormone production from adrenal tumors tends to confuse both patients and physicians--but it shouldn't. The reason is that very few doctors have significant experience with obtaining and interpreting laboratory values when it comes to adrenal hormones.

Cortisol production is controlled by another hormone called ACTH produces by the pituitary. When testing for Cushing's syndrome, it is important to measure both cortisol and ACTH levels. Cortisol production is controlled by another hormone called ACTH produces by the pituitary. When testing for Cushing's syndrome, it is important to measure both cortisol and ACTH levels.

Blood Tests and Urinary Tests. The correct laboratory evaluation includes both urinary tests as well as blood tests because some of the adrenal hormones can build up in the blood while others build up in the urine. There are laboratory tests that are first done to screen for pheochromocytoma, Cushing’s syndrome and primary hyperaldosteronism (Conn’s syndrome). We discuss all of these tests in-depth within the sections dedicated to each adrenal tumor type. Sometimes these laboratory tests are unequivocal (i.e. the diagnosis is a slam dunk), and the patient can go straight to curative surgery (Mini Back Scope Scope Adrenalectomy (MBSA) is always the preferred operation!).

Sometimes, however, these laboratory tests are borderline or difficult to interpret because of interference by medications. You can always contact us to review laboratory tests. This is all we do. For us it is very easy to evaluate laboratory testing since we have seen hundreds and thousands of adrenal patients. Sometimes when the laboratory tests, are borderline they have to be repeated. In addition, there are some confirmatory test that needs to be performed. For a detailed discussion of laboratory (both blood, urine and other tests) evaluation of each entity go to the individual pages of pheochromocytoma, cushing’s Syndrome, primary hyperaldosteronism conn's Syndrome, and adrenocortical cancer.

Testing for sex-hormone excess is also advocated by the European Society of Endocrinology which recommends testing for DHEA-S, androstenedione, 17-hydroxyprogesterone, testosterone for women and estradiol for men and post-menopausal women if there are clinical signs of virilization or suspicion for adrenal cancer.

Remember, if any adrenal tumor is producing hormone, or if it is more than 3-4 cm in diameter, the tumor needs to be removed surgically. For most patients, the Mini-Back Scope Adrenalectomy (the Mini-PRSA) is by far the best operation. Chose your surgeon wisely because your life depends on it--Contact Dr. Carling if you have any questions.

What Are the Most Common and Important Tests for Adrenal Tumors?

The correct laboratory evaluation includes both urinary tests as well as blood tests because some of the adrenal hormones can build up in the blood while others build up in the urine. The most commonly used and important blood, urine and other tests are listed here:

Typical adrenal adenoma overproducing cortisol causing Cushing’s syndrome. Typical adrenal adenoma overproducing cortisol causing Cushing’s syndrome.

  • Testing for Pheochromocytoma (medulla-arising tumors)

    • Blood Test
    • Catecholamines, fractionated
    • Epinephrine
    • Norepinephrine
    • Dopamine

    • 24h Urine Collection
    • Metanephrine
    • Normetanephrine
    • Metanephrines, total
    • Dopamine
    • VMA
    • Catecholamines, total
  • Testing for Cushing's & Conn's syndromes, as well as Adrenal Cancer (cortex-arising tumors)

    • Tests for Cushing's syndrome
    • A.M. Cortisol
    • ACTH (low)
    • Low dose dexamethasone test
    • Late-night salivary cortisol testing (saliva test)
    • 24h urine collection for UFC = Urinary Free Cortisol

    • Tests for Conn's syndrome
    • Potassium (K+; low)
    • Plasma aldosterone concentration (PAC)
    • Plasma renin activity (PRA; low)
    • PRA/PAC ratio
    • Adrenal vein sampling (Interventional radiology study)
    • 24h urine collection for Aldosterone

    • Tests for Sex-Steroid Hormones and Adrenal Cancer
    • Testing for Cushing's syndrome and Conn's syndrome as above
    • DHEAS
    • 17-OH-Progesterone
    • Androstenedione
    • Total Testosterone
    • Free Testosterone
    • 17-Beta-estradiol (serum, only in men and postmenopausal women)

      • NOTE: When you have the disease all this tests are typically high (elevated), except those indicated as low They classically have reduce levels.

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