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Adrenal Mass, BP Increase, Anxiety, Fast Heart Beat. Generalized Anxiety Disorder?

Posted on Tue, 29 May 2012

Question: Hello, last November 2010 I had a cat scan of the abdomen. One finding was: "THere is a 3 cm right adrenal mass present. Some low density areas within this suggest fat most likely indicating a benign lesion"
Over the last four months I have seen a modest increase in my BP, and an increase in anxiety and also have noticed my heart rate beating louder and faster.

My questions are:

1). I understand that a low density mass is benign. But can it still cause problems? Could this benign mass be causing the increase in my anxiety?
2). Since this scan was done 9 months ago, is it possible that it wasn't causing symptoms at that time but now is causing symptoms. My GP decided it wasn't worth following up because itt was benign. But the doctor did not know that I had a diagnosis of Generalized Anxiety Disorder. Can a adrenal mass change from non functioning to functioning?
3). The wording on the scan says "some low density areas within this suggest fat" Now I know it is benign but could it still be a functioning mass?
4). Is it true that the best test is a 24 hour urine sample?

Answered by Dr. V. Kumaravel (15 hours later)

Hello,

Thanks for posting your query.

I understand that you have hypertension and had been diagnosed as Benign adrenal mass of size 3cm as per CT scan.

There are three things to be considered in case of adrenal mass:
1. Size.
2. Functional status.
3. Benign or malignant.

Any tumor size more than 4 centimeters and which is rapidly growing is a concern.

In your case, it is 3 cm, but I don't have a follow-up size. you might require a repeat scan now to assess the size.

Query 1 and 2: There is possibility that anxiety is due to the adrenal mass. It could be functional lesion also. But it needs evaluation.

3: Benign adrenal mass is classified as functional and non-functional based on overproduction of hormones. If it secretes more hormones it is called as functional mass.

Symptoms you are facing could be due to functional mass.

4: You would definitely require a 24 urine sample and other blood tests to confirm whether it is a functioning or non functioning mass.

If it is a non functioning mass, you may also require CT guided Biopsy to confirm whether it is benign or malignant or any other mass.

I would recommend you to consult your Physician/Endocrinologist for complete investigations to assess the functionality of the mass including 24 hrs urine sample and a repeat scan to assess the size of the mass.

Do not be worried as these are easily treatable even if it is a functioning mass.

Hope this answers your query.

I will be available for follow up queries if any.

Regards.

Above answer was peer-reviewed by : Dr. Jyoti Patil

Follow up: Dr. V. Kumaravel (3 hours later)

1). Somebody mentioned to me that since the mass had low density portions indicative of fat that the mass can't be a functioning mass because fatty masses are never functioning. My research over the internet indicates that tumors made up of fat can be functioning.

2). Can a mass go from non functioning to functioning?

I am seeing my doctor tomorrow to coordinate the 24 hour urinalysis.

Answered by Dr. V. Kumaravel (23 minutes later)

Hello

Thanks for your follow-up.

1. Adrenal tumors can function to secrete hormones like adrenaline, noradrenaline, aldosterone, cortisol and androgens. Your hormonal and urine tests should be normal to say your tumors is nonfunctioning. Radiological imaging like CT scans cannot totally differentiate between functioning and nonfunctioning mass.

2. Possiblity exists that a mass can go from nonfunctioning to functioning, but rare.

I am sure your doctor will be able to sort out your issue.

Take care and best wishes.

regards

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Raju A.T