Best Adrenal Cancer Doctors in Hyderabad — CION's Dedicated Adrenal Cancer Panel

Adrenal cancer requires a coordinated team across surgical oncology (for adrenalectomy), medical oncology (for mitotane or chemotherapy), endocrinology (for hormonal workup), and anaesthesiology (for pheochromocytoma surgery). At CION, every adrenal cancer case is reviewed by a multidisciplinary tumour board, with surgical leadership by Dr. Vajja Sandeep Kumar (DrNB Surgical Oncology, HPB Lead — adjacent anatomical expertise) and medical oncology by Dr. Naresh Gundu (DM Medical Oncology).

Hormonal workup before surgery is non-negotiable for adrenal tumours. Standard workup includes: cortisol (overnight 1-mg dexamethasone suppression test, 24-hour urinary cortisol), aldosterone-renin ratio (for primary aldosteronism), plasma free metanephrines or 24-hour urinary metanephrines (for pheochromocytoma), and DHEA-S (for androgen-producing tumours). A tumour that is hormone-producing ("functional") requires specific preoperative preparation — alpha-blockade for pheochromocytoma; steroid coverage for cortisol-producing tumours. Without this workup, surgery can be unsafe and post-operative course unpredictable.

These are different cancers from the same gland. Pheochromocytoma arises from the adrenal medulla (catecholamine-producing chromaffin cells); most are benign, 10% malignant, and many are hereditary. Treatment is laparoscopic adrenalectomy after 7–14 days of alpha-blockade preparation. Adrenocortical carcinoma (ACC) arises from the adrenal cortex (steroid-producing cells); ACC is malignant, often large at diagnosis, and treated with open adrenalectomy (NOT laparoscopic — risk of tumour rupture). ACC may need adjuvant mitotane therapy and has a higher recurrence risk.

Mitotane is the unique adrenocortical-specific therapy — an oral medication that selectively destroys adrenal cortical cells and is used in adrenocortical carcinoma (ACC). It is given as adjuvant therapy after surgery for high-risk ACC, in combination with chemotherapy (EDP-M) for advanced disease, or as monotherapy for selected advanced cases. Mitotane requires close monitoring of blood levels (target 14–20 mcg/mL), regular cortisol and steroid replacement (since it suppresses cortisol production), and management of side effects (GI symptoms, neurological effects, hypothyroidism). Treatment may continue for 2+ years.

Pheochromocytomas produce catecholamines (adrenaline, noradrenaline) — surgical manipulation can release a massive catecholamine surge causing dangerous hypertensive crisis, arrhythmia, or cardiac instability. Alpha-blockade (phenoxybenzamine or selective alpha-1 blockers like doxazosin) for 7–14 days BEFORE surgery counteracts this — it blocks the vascular response to catecholamines, allowing safe surgery. Beta-blockers are added only AFTER adequate alpha-blockade (using beta-blocker first can paradoxically worsen hypertension). Adequate preparation is non-negotiable. This is one of the most important quality measures for pheochromocytoma surgery.

Open adrenalectomy is the preferred approach for suspected ACC because the surgical principle is en-bloc resection without tumour rupture or spillage. Laparoscopic adrenalectomy for ACC has been associated with higher rates of tumour rupture, peritoneal recurrence, and worse oncologic outcomes in published series. For known or strongly suspected ACC, open surgery via the appropriate approach (subcostal, thoracoabdominal for large tumours) allows controlled wide resection. Laparoscopic approach may be considered for very early small ACC by experienced surgeons but open remains the safer default. Pheochromocytoma and benign adrenal adenomas are typically appropriate for laparoscopic approach.

Yes, in many cases. Pheochromocytoma and paraganglioma have a 30–40% hereditary component — mutations in RET (MEN-2), VHL (von Hippel-Lindau), NF1 (neurofibromatosis), and SDHB/SDHD/SDHA (hereditary paraganglioma syndromes). Adrenocortical carcinoma in young patients (<40) or with certain features may indicate Li-Fraumeni syndrome (TP53 mutation). Genetic counselling and testing is part of comprehensive workup, and family screening may be recommended for confirmed mutations. CION coordinates genetic counselling through partner network.

After unilateral adrenalectomy (one adrenal removed), the other adrenal usually provides adequate hormone function and no replacement is needed long-term — though temporary steroid coverage may be needed during the recovery period, especially after cortisol-producing tumour removal. After bilateral adrenalectomy (rare — both adrenals removed), lifelong steroid replacement (hydrocortisone + fludrocortisone) is essential. The endocrinology coordination at CION includes long-term follow-up for steroid replacement where applicable.

A second opinion is especially valuable for adrenal cancer because of how rare it is — even oncologists at general centres see few cases. At CION the second opinion is free, written, and yours to keep — our multidisciplinary tumour board reviews your imaging, hormonal workup, biopsy/pathology if available, and existing recommendation and provides a documented opinion you can take anywhere.

Costs vary by tumour type and treatment. Open adrenalectomy for ACC ranges approximately ₹2,50,000 to ₹5,00,000. Laparoscopic adrenalectomy for pheochromocytoma ranges ₹2,00,000 to ₹4,00,000. Mitotane therapy is expensive — ₹2,50,000 to ₹6,00,000+ per year depending on dosing. EDP-M chemotherapy adds further cost. Hormonal workup and genetic counselling typically ₹15,000 to ₹40,000. For a detailed cost breakdown, see our adrenal cancer treatment in Hyderabad page. Every CION patient receives a written, itemised cost estimate. Aarogyasri, EMI, and cashless insurance accepted.