Medically reviewed by Dr. Owais Mohammed, MBBS, MD General Medicine, Medical Oncologist · Last reviewed May 2026
The adrenal glands are small, but their cancers are complex. At CION Cancer Clinics, our surgical and medical oncology team manages the full range of adrenal cancer — from open adrenalectomy for adrenocortical carcinoma to carefully prepared laparoscopic surgery for pheochromocytoma, with mitotane therapy for high-risk cases — across 7 Hyderabad locations, backed by NABH accreditation and NCCN protocol-driven care.
The vast majority of adrenal masses found on CT or MRI scans are benign — non-cancerous growths called incidentalomas, discovered by chance during scans done for other conditions. Most never require treatment. However, all adrenal masses need evaluation to determine whether they are producing excess hormones and whether they have any features suggesting cancer. A specialist assessment can usually provide clarity within a few targeted investigations.
The adrenal glands have two distinct layers, each producing different hormones — and each giving rise to a different type of cancer. Identifying which type is present is essential before any surgery is planned.
The cortex produces cortisol (the body's main stress hormone), aldosterone (regulates blood pressure and salt balance), and sex hormones (androgens and oestrogens). Cancer of the adrenal cortex is called adrenocortical carcinoma (ACC) — a rare but aggressive cancer, most common in adults aged 40 to 50 and in young children. It is the more common primary adrenal cancer.
The medulla produces adrenaline (epinephrine) and noradrenaline (norepinephrine) — the hormones that trigger the 'fight or flight' response. A tumour of the medulla is called a pheochromocytoma. Most pheochromocytomas are benign, but about 10 to 15% are malignant — defined by spread to lymph nodes or other organs. Treatment differs significantly from ACC.
Most people who are told they have an adrenal mass did not go to their doctor because of adrenal symptoms. They had a CT scan or MRI for back pain, abdominal discomfort, or a routine check-up — and the scan showed a mass on or near the adrenal gland. This finding is so common that it has its own name: an adrenal incidentaloma.
The vast majority of adrenal incidentalomas — more than 80% — are benign and never require treatment. However, every adrenal incidentaloma needs to be evaluated for two things:
Is it producing hormones? — Some benign adrenal tumours overproduce cortisol, aldosterone, or adrenaline, causing significant health problems even without being cancerous. A specific set of blood and urine tests checks for this.
Does it look like cancer? — Certain imaging characteristics on CT — size, density, irregular borders, and growth over time — raise suspicion for adrenocortical carcinoma. Adrenal masses larger than 4cm and those with suspicious imaging features require specialist evaluation and often surgical removal.
CION's oncology and endocrinology team evaluates adrenal incidentalomas with the standard hormone testing protocol and imaging review to determine whether watchful monitoring, medical management, or surgery is appropriate.
About 60% of adrenocortical carcinomas produce hormones in excess. The specific hormones produced determine the symptoms. Understanding these patterns is how patients first recognise that something is wrong with the adrenal gland.
Weight gain concentrated around the abdomen and face ('moon face'), wide purple stretch marks, thinning skin and easy bruising, high blood pressure, high blood sugar (sometimes triggering diabetes), muscle weakness in the thighs, mood changes, and in women irregular or absent periods. These changes develop over months and are often attributed to lifestyle before the underlying adrenal tumour is found.
Some ACC tumours produce male sex hormones (androgens) in excess. In women this causes virilisation — unwanted growth of facial and body hair, a deepening voice, acne, and enlargement of the clitoris. In men, the process is less noticeable because androgens are normally present. In children, androgen-producing adrenal tumours cause premature puberty.
Pheochromocytoma produces adrenaline in surges. The classic triad: sudden severe headache (often the worst of the patient's life), profuse sweating without cause, and rapid heart rate. Episodes last 15 to 20 minutes — often mistaken for panic attacks, anxiety, or migraine. Persistent high blood pressure in younger people should prompt evaluation.
For most adrenal cancers, no clear cause is found. However, several inherited genetic conditions significantly raise the risk.
Genetic testing is recommended for all patients with pheochromocytoma and for selected ACC patients, particularly those diagnosed under 40 or with a family history of adrenal tumours or related cancers.
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Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Same-week appointments across 7 Hyderabad locations — bring your CT, MRI and any hormone tests if available.
Diagnosis follows a fixed order — hormone evaluation always precedes imaging-only decisions, and ruling out pheochromocytoma is mandatory before any adrenal surgery.
Cortisol suppression test (overnight dexamethasone) for excess cortisol; plasma and urine catecholamines for adrenaline/noradrenaline (mandatory to rule out pheochromocytoma); aldosterone-to-renin ratio for excess aldosterone; adrenal androgens and oestrogens for ACC. Ruling out pheochromocytoma is mandatory before any adrenal surgery — regardless of how benign the tumour appears on imaging.
A dedicated adrenal CT with specific density measurements (Hounsfield units) characterises most adrenal masses with high accuracy. Features that strongly suggest ACC: size greater than 4cm, irregular borders, high density on unenhanced CT, slow washout of contrast. MRI provides additional characterisation and assesses for vascular invasion. For pheochromocytoma, MRI shows a characteristic very bright appearance on specific sequences.
For staging ACC and assessing for metastatic disease, PET-CT is arranged through CION's specialist imaging referral network, starting from ₹9,999 to ₹16,000. PET-CT is particularly valuable for detecting distant spread and guiding multi-modal treatment planning.
Biopsy of an adrenal mass is not routinely done. If imaging and hormone tests clearly indicate a primary adrenal tumour requiring surgery, the patient proceeds directly to operation without biopsy. Biopsy is considered only when the mass may be a metastasis from another known cancer elsewhere in the body. Biopsy of a suspected pheochromocytoma is dangerous and is never performed.
ACC is staged using the ENSAT (European Network for Study of Adrenal Tumours) staging system — the international standard. Stage at diagnosis is the most important predictor of outcome. Pheochromocytoma does not use this staging system; malignant pheochromocytoma is defined by spread to lymph nodes or distant organs.
| Stage | Tumour characteristics | Spread | 5-Year Survival* | Primary treatment |
|---|---|---|---|---|
| Stage I | Tumour ≤5cm, confined to adrenal gland | No node involvement, no spread | 60–80% | Open adrenalectomy; adjuvant mitotane for high-risk features |
| Stage II | Tumour >5cm, confined to adrenal gland | No node involvement, no spread | 50–70% | Open adrenalectomy; adjuvant mitotane recommended |
| Stage III | Invasion of surrounding tissue or nearby lymph nodes | Local extension; no distant spread | 25–45% | Open adrenalectomy + adjuvant mitotane + consider chemotherapy |
| Stage IV | Invasion of adjacent organs or distant metastases | Lung, liver, or distant lymph nodes | 10–20% | Mitotane + chemotherapy; surgery for resectable metastases |
*5-year overall survival ranges from published ACC outcomes data. Individual outcomes depend on completeness of surgical resection, tumour grade, and response to adjuvant therapy.
Surgery is the only potentially curative treatment for adrenal cancer. For ACC, the goal is complete removal with a clear margin. For pheochromocytoma, complete removal of the affected gland cures the disease in the majority of cases.
For suspected adrenocortical carcinoma, open surgery — through an abdominal or flank incision — is the preferred approach. It allows the surgeon to fully assess tumour extent, remove it intact without rupture (which would spread cancer cells), take surrounding tissue and involved lymph nodes, and inspect adjacent structures. For large ACC tumours (>6cm) or those showing local invasion, open surgery significantly reduces the risk of incomplete removal.
For smaller adrenal tumours without features suggesting ACC — and as the standard approach for pheochromocytoma — laparoscopic adrenalectomy uses small keyhole incisions and a camera-guided instrument. Benefits: shorter hospital stay (1–2 days vs. 4–5), significantly less post-operative pain, faster return to normal activities, and lower complication rates. Every adrenal tumour is assessed for the most appropriate surgical approach before operating.
Every patient with a pheochromocytoma must receive 10 to 14 days of specific blood pressure medicines before surgery. This preparation blocks the effect of the adrenaline surges the tumour can release when handled during the operation. Without this preparation, surgery on a pheochromocytoma can trigger a dangerous spike in blood pressure — a preventable emergency. If you are scheduled for pheochromocytoma surgery and have not been prescribed blood pressure medicines in advance, speak to your surgeon about this before your operation date.
This is the most important safety message for any patient preparing for pheochromocytoma surgery, and no local hospital treatment page in Hyderabad currently explains it clearly.
Pheochromocytoma tumours produce adrenaline continuously, and in surges. During surgery, handling of the tumour can trigger a massive, sudden release of stored adrenaline — causing blood pressure to spike to extremely dangerous levels (a hypertensive crisis). Without preparation, this can lead to stroke, heart attack, or cardiac arrest on the operating table.
To prevent this, every patient with pheochromocytoma must receive 10 to 14 days of blood pressure control medicines before their operation. This preparation uses a specific type of blood pressure medicine (alpha-blockers) that blocks the effect of adrenaline on blood vessels. Only after this preparation is established — and blood pressure is stable — is surgery safe. A second type of blood pressure medicine may be added in the final days before surgery.
This preparation is not optional. Removing a pheochromocytoma without this preparation is one of the most preventable causes of intra-operative catastrophe in surgical oncology. CION's team coordinates this preparation with endocrinology specialists as a standard part of pheochromocytoma surgical planning.
After surgery for adrenocortical carcinoma, the oncology team assesses whether additional treatment is needed to reduce the risk of recurrence. For high-risk cases — larger tumours, higher grade, positive margins, or Stage III disease — adjuvant mitotane is recommended.
Mitotane is an unusual medicine in oncology: it is the only drug in the world developed specifically to destroy adrenal cortex cells. It works by accumulating in adrenal tissue and disrupting the production of hormones, ultimately causing adrenal cell death. It is given as daily oral tablets, typically for at least 2 years after surgery for high-risk ACC.
For advanced or inoperable ACC, mitotane is the primary systemic treatment, often combined with chemotherapy. CION's medical oncology team manages mitotane dosing, blood level monitoring, and hormone replacement as an integrated care package.
Adrenal cancer management requires surgical oncology, medical oncology, endocrinology, and radiology working together. At CION, every adrenal cancer case is reviewed by our multidisciplinary team before treatment begins.
When you're choosing where to be treated for the best adrenal cancer hospital in Hyderabad, what you're really looking for is a team that has done this surgery before — and the protocols to do it safely.
Costs are indicative ranges in INR. A personalised cost estimate is provided following your initial oncology consultation at CION. EMI options are available; CION works with all major TPAs for cashless hospitalisation.
| Treatment / Investigation | Approximate Cost (INR) | Notes |
|---|---|---|
| Hormone Evaluation (blood + urine) | ₹3,000 – ₹10,000 | Cortisol, catecholamines, aldosterone, androgens |
| CT Adrenal (dedicated protocol) | ₹3,000 – ₹8,000 | With density measurement for incidentaloma characterisation |
| PET-CT Scan (ACC staging) | ₹9,999 – ₹16,000 | Through CION's specialist imaging referral network |
| Open Adrenalectomy (ACC) | ₹2,50,000 – ₹6,00,000 | Larger incision; 3–5 day stay; preferred for ACC |
| Laparoscopic Adrenalectomy | ₹1,50,000 – ₹4,00,000 | For pheochromocytoma and smaller benign-appearing tumours; 1–2 day stay |
| Pre-Surgery Alpha-Blockade (10–14 days) | ₹5,000 – ₹15,000 | Blood pressure preparation before pheochromocytoma surgery |
| Mitotane Tablets (per month, adjuvant) | ₹20,000 – ₹60,000 | Ongoing; blood level monitoring required; hormone replacement added |
| Chemotherapy for Advanced ACC (per cycle) | ₹50,000 – ₹1,50,000 | For Stage IV or high-risk disease alongside mitotane |
| Full Treatment (Stage I–II ACC, surgery + adjuvant mitotane) | ₹3,00,000 – ₹8,00,000+ | Depends on mitotane duration |
Financial support: EMI facility available for all patients · CION works with all major TPAs for cashless hospitalisation · Aarogyasri / CGHS / ECHS / ESI accepted where applicable.
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Start Your Story. Book Free Consultation.Adrenal cancer develops in the adrenal glands — two small glands that sit on top of the kidneys and produce hormones regulating blood pressure, stress response, and metabolism. Two distinct cancers arise here: adrenocortical carcinoma (ACC), which grows from the outer layer (cortex) and is the more common primary adrenal cancer in adults; and malignant pheochromocytoma, which grows from the inner layer (medulla) and is defined by its spread to lymph nodes or other organs. Both are rare. Many adrenal tumours are benign and found incidentally on scans done for other reasons.
Symptoms depend on whether the tumour produces hormones. About 60% of adrenocortical carcinomas overproduce hormones, causing weight gain around the abdomen and face, wide purple stretch marks, high blood pressure, high blood sugar, and muscle weakness from excess cortisol (Cushing's syndrome); or excess facial and body hair, deepening voice, and acne in women from excess androgens (virilisation). Pheochromocytoma causes sudden episodes of severe headache, profuse sweating, and rapid heartbeat — often mistaken for panic attacks. Non-hormone-producing adrenal cancers may cause back or abdominal pain or be found by chance on a scan.
Both are adrenal cancers but arise from different layers of the gland. Adrenocortical carcinoma (ACC) grows from the outer layer (cortex) and often produces cortisol or androgens in excess. It is the more common primary adrenal cancer and is treated primarily with open surgery followed by mitotane. Pheochromocytoma grows from the inner layer (medulla) and produces adrenaline — causing episodic hypertension, headache, and sweating. Most pheochromocytomas are benign; only those that spread to other organs are malignant. Before surgery for pheochromocytoma, blood pressure must be controlled with specific medicines for 10 to 14 days; no such preparation is needed for ACC.
Yes — for early-stage adrenocortical carcinoma (Stage I and II), complete surgical removal offers 5-year survival of 60 to 80%. The most important factor is whether the surgeon achieves complete removal with clear margins at the first operation. Stage III disease carries 25 to 45% 5-year survival with surgery plus mitotane. Stage IV is more difficult to cure but mitotane-based therapy controls disease in some patients. Pheochromocytoma that is completely removed surgically is cured in the majority of patients; malignant pheochromocytoma (with spread) requires ongoing systemic management.
Adrenalectomy is the surgical removal of the adrenal gland. For adrenocortical carcinoma, open surgery (through an abdominal or flank incision) is preferred to ensure complete removal and reduce the risk of tumour rupture. For pheochromocytoma and smaller tumours without features suggesting cancer, laparoscopic adrenalectomy — using small keyhole incisions with a camera — is the standard approach. This allows a shorter hospital stay (1 to 2 days), less pain, and faster recovery. After removal of one adrenal gland, the remaining gland compensates and hormone replacement is not required. If both glands are removed, lifelong cortisol replacement is necessary.
Mitotane is the only medicine in the world designed specifically to destroy adrenal cortex cells. It is given as daily oral tablets after surgery for high-risk adrenocortical carcinoma, typically for at least 2 years, to reduce the risk of recurrence. For inoperable or advanced ACC, mitotane is the primary treatment, sometimes combined with chemotherapy. It requires regular blood level monitoring to ensure effective dosing. Because it suppresses normal adrenal hormone production, patients on mitotane take cortisol replacement tablets throughout treatment. Reliable contraception is required during mitotane therapy.
For most patients, no clear cause is found. Several inherited genetic conditions significantly increase risk: Li-Fraumeni syndrome (TP53 gene fault) is linked to ACC, particularly in children and young adults; MEN2 syndrome is strongly associated with pheochromocytoma; SDH gene mutations are the most common hereditary cause of pheochromocytoma and carry a higher risk of malignancy; Beckwith-Wiedemann syndrome is linked to childhood ACC. Genetic testing is recommended for all pheochromocytoma patients and for ACC diagnosed in people under 40.
An adrenal incidentaloma is an adrenal mass found by chance during CT or MRI scanning done for an unrelated reason. They are very common — found in 1 to 5% of all abdominal CT scans. The vast majority (over 80%) are benign and never require treatment. However, all incidentalomas need evaluation with specific hormone blood and urine tests (to check for excess hormone production) and imaging review (to assess the risk of cancer based on size and CT characteristics). CION's team performs this structured evaluation and advises on whether monitoring, medical treatment, or surgery is appropriate.
Hormone evaluation (blood and urine tests): ₹3,000–10,000. Dedicated adrenal CT: ₹3,000–8,000. PET-CT for ACC staging: ₹9,999–16,000 (through CION's imaging referral network). Open adrenalectomy for ACC: ₹2,50,000–6,00,000. Laparoscopic adrenalectomy for pheochromocytoma: ₹1,50,000–4,00,000. Pre-surgery blood pressure medicines: ₹5,000–15,000. Mitotane tablets (monthly): ₹20,000–60,000. Full Stage I–II ACC treatment (surgery + adjuvant mitotane): ₹3,00,000–8,00,000+. A personalised estimate is provided after your CION consultation. EMI options are available.
Absolutely — and for adrenal cancer, a second opinion is particularly valuable in three situations: if pheochromocytoma has been diagnosed but no blood pressure preparation medicine has been prescribed before surgery (this preparation is mandatory and its absence is a serious concern); if an adrenal mass has been recommended for immediate surgery without prior hormone evaluation (hormone testing must be done first); and if adrenocortical carcinoma has been confirmed and mitotane has not been discussed for high-risk Stage II or Stage III disease. CION offers a dedicated Second Opinion service.
