Is Blood in the Stool a Symptom of Adrenal Cancer?

Blood in the stool (rectal bleeding, hematochezia, or melena) is not a typical symptom of adrenal cancer. The common symptoms of adrenal cancer relate to abdominal discomfort, back pain, unintended weight loss, loss of appetite, and signs of hormone overproduction (such as features of Cushing syndrome). ^{[1] [2]} Adrenal cancers most often present with hormone-related changes like weight gain, muscle weakness, purple stretch marks, easy bruising, high blood pressure, and high blood sugar when excess cortisol is produced; changes in sex hormones can also occur less commonly. ^{[3] [4]}

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Typical Symptoms of Adrenal Cancer

• Abdominal or back pain: Tumor growth in the adrenal gland can cause belly pain or back pain, especially as tumors enlarge. ^[2]
• Unintended weight loss and appetite loss: Systemic effects of cancer can lead to losing weight without trying and decreased appetite. ^[5]
• Hormone-related signs: Excess cortisol (Cushing syndrome) can cause weight gain, muscle weakness, purple stretch marks, easy bruising, high blood pressure, and high blood sugar. ^[3]
• Sex hormone changes: Less commonly, tumors may produce estrogen or testosterone, leading to menstrual irregularity, hair changes, breast tissue growth in males, or testicular shrinkage. ^[4]
• Aldosterone excess: Rarely, aldosterone production causes high blood pressure and low potassium. ^[4]

These symptom patterns reflect either mass effect (pressure on nearby organs) or hormonal excess, not direct gastrointestinal bleeding. ^[6]

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Why Blood in the Stool Is Uncommon in Adrenal Cancer

The adrenal glands sit above the kidneys in the retroperitoneum (the back of the abdominal cavity). Adrenal tumors do not involve the intestinal lumen directly, so they do not usually cause bleeding into the stool. ^[7] When adrenal cancers become large, they can press on nearby structures and cause abdominal fullness or pain, but this is different from causing bleeding into the intestines. ^[6]

Although rare, adrenal cortical carcinomas can occasionally present with retroperitoneal hemorrhage (internal bleeding in the back of the abdominal cavity), which may cause sudden abdominal pain, instability, or a drop in blood counts; however, retroperitoneal bleeding does not typically manifest as blood in the stool. ^[8] In case reports, adrenocortical carcinomas have ruptured and bled within the retroperitoneum, producing acute symptoms rather than gastrointestinal bleeding. ^[9]

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Could Adrenal Cancer Ever Be Linked to GI Bleeding?

• Direct intestinal invasion is uncommon: Adrenal cancers can spread locally and to organs such as the liver or kidney, but involvement of the bowel leading to stool blood is not a recognized typical pattern. ^[7]
• Metastatic disease patterns: Adrenal glands are a common site for metastases from other cancers, especially lung, breast, and kidney; conversely, colorectal cancer can spread to the adrenals, but this scenario does not mean adrenal cancer causes blood in stool it is the primary colorectal cancer that causes GI bleeding. ^[10]
• Portal hypertension from metastasis (rare): There are rare reports of adrenal carcinoma metastasis causing regional portal hypertension through splenic vein obstruction, which can lead to abdominal varices and potential GI bleeding; however, this is exceptionally rare and not a standard presentation. ^[11]

Overall, blood in the stool points more toward gastrointestinal conditions (like hemorrhoids, anal fissures, inflammatory bowel disease, diverticula, colon polyps, or colorectal cancer) rather than adrenal cancer. It is important to evaluate rectal bleeding with a GI-focused workup when appropriate.

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What To Do If You Notice Blood in Your Stool

• Seek medical evaluation: Because GI bleeding has many potential causes ranging from benign to serious discuss any rectal bleeding with a clinician for appropriate assessment.
• Consider risk-based testing: Depending on age, symptoms, and risk factors, your clinician may recommend tests such as stool occult blood testing, blood counts, iron studies, and endoscopy (sigmoidoscopy or colonoscopy).
• Address associated symptoms: Report accompanying signs like abdominal pain, changes in bowel habits, unexplained weight loss, or fatigue, which can guide the urgency and type of testing.
• Adrenal-specific signs: If you also have features suggestive of hormone excess (rapid weight gain, muscle weakness, purple stretch marks, easy bruising, difficult-to-control blood pressure or blood sugar), your clinician may add adrenal-focused testing (hormone panels and imaging). ^{[3] [5]}

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Key Takeaways

• Blood in the stool is not a recognized typical symptom of adrenal cancer. ^[2]
• Adrenal cancer usually presents with abdominal/back pain and hormone-related changes, particularly features of Cushing syndrome when cortisol is overproduced. ^[3]
• Rare adrenal events like retroperitoneal hemorrhage do not usually cause stool blood, but can cause acute internal bleeding and abdominal symptoms. ^{[8] [9]}
• Rectal bleeding should be evaluated for gastrointestinal causes, with testing tailored to your history and risk profile.

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References

• Signs and symptoms of adrenal cancer include belly pain, back pain, unintended weight loss, and loss of appetite; many cases involve hormone changes, especially excess cortisol. ^{[2] [5] [3]}
• Less common hormone patterns include excess sex hormones and aldosterone. ^[4]
• Mass effect symptoms (abdominal pain, fullness) can occur when the tumor presses on nearby organs. ^[6]
• Surgical management may involve removal of adjacent organs if spread is found; typical spread patterns emphasize nearby structures rather than bowel lumen involvement. ^[7]
• Rare case reports describe retroperitoneal hemorrhage from adrenocortical carcinoma. ^{[8] [9]}
• Metastasis patterns related to the adrenals and rare portal hypertension from adrenal carcinoma metastasis have been reported. ^[11]
• Adrenal metastasis from colorectal cancer exists, but GI bleeding relates to the colorectal primary, not adrenal cancer. ^[10]