Based on PubMed | Can adrenal cancer cause dizziness, and what underlying factors might lead to this symptom?

Overview

Dizziness is not a classic hallmark of adrenal cancer, but it can occur indirectly due to the cancer’s effects on hormones, blood pressure, electrolytes, blood sugar, and cardiovascular function. Adrenocortical carcinoma (ACC) and other adrenal tumors sometimes produce excess hormones (cortisol, aldosterone, or sex steroids), and these changes can trigger conditions that make someone feel lightheaded, faint, or “off balance.” Malignant adrenal tumors are rare, and most adrenal tumors are benign and asymptomatic, but when hormonal excess is present, dizziness can be part of the clinical picture. ^{[1] [2]}

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How adrenal tumors can lead to dizziness

1) Blood pressure swings (high or low)

• Excess cortisol from adrenal cortex tumors can contribute to high blood pressure, which may produce headaches, palpitations, and occasionally lightheadedness, especially with sudden changes. ^[2]
• Rarely, adrenal cancers make aldosterone, causing high blood pressure with low potassium; both the elevated blood pressure and electrolyte imbalance can cause weakness and dizziness. ^{[3] [4] [5]}
• Catecholamine-producing tumors of the adrenal medulla (pheochromocytomas) cause episodes of very high blood pressure with palpitations, sweating, and can also cause orthostatic hypotension (a drop in blood pressure upon standing), leading to dizziness or near-fainting. ^{[6] [7]}

2) Electrolyte disturbances (especially low potassium)

• Mineralocorticoid excess (aldosterone-like activity) causes the kidneys to waste potassium, leading to hypokalemia; low potassium commonly causes muscle weakness, fatigue, and can contribute to dizziness or palpitations. This pattern has been documented in adrenal cortical carcinoma mimicking primary aldosteronism. ^{[4] [5] [8]}

3) High blood sugar and metabolic effects

• Cortisol excess (Cushing syndrome) can raise blood sugar and cause fatigue, muscle weakness, and vascular changes, which may make some people feel lightheaded. Adrenal cancers most often produce cortisol and can cause Cushing features alongside hypertension and hyperglycemia. ^{[2] [9]}

4) Autonomic and cardiovascular effects

• Pheochromocytomas can cause rapid swings in vascular tone due to surges of epinephrine/norepinephrine, producing paroxysmal hypertension, tachycardia, and sometimes orthostatic hypotension; these mechanisms are well-recognized causes of dizziness in this tumor type. ^{[7] [6]}
• Severe catecholamine excess may precipitate arrhythmias or stress cardiomyopathy (e.g., Takotsubo), which can manifest with presyncope or dizziness. ^[7]

5) Compression or systemic illness

• Large adrenal masses may cause abdominal fullness, pain, or weight loss; systemic illness and deconditioning can indirectly contribute to lightheadedness in some individuals. ^[10]

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Typical hormonal patterns and related symptoms

• Cortisol excess (Cushing syndrome): weight gain, muscle weakness, purple stretch marks, bruising, high blood pressure, and high blood sugar; these changes can indirectly provoke dizziness via blood pressure and glucose fluctuations. ^{[2] [11] [9]}
• Aldosterone excess (hyperaldosteronism pattern): high blood pressure with low potassium, increased thirst and urination, generalized weakness; potassium loss and blood pressure changes may lead to dizziness. ^{[3] [12]}
• Catecholamine excess (pheochromocytoma): paroxysmal headaches, sweating, palpitations, wide blood pressure swings, and orthostatic hypotension; dizziness is common in this context. ^{[6] [7]}

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Key distinctions: adrenal cancer vs. other adrenal tumors

• Adrenocortical carcinoma (ACC): a rare malignant tumor of the adrenal cortex; it often secretes cortisol and less commonly aldosterone or sex hormones, leading to Cushing-like features, hypertension, and metabolic derangements that can include dizziness. ^{[2] [13]}
• Aldosteronoma (benign) vs. ACC with mineralocorticoid excess: benign aldosteronomas classically cause resistant hypertension and low potassium; ACC can rarely mimic this picture, and hypokalemia is a practical clue to investigate adrenal causes. ^{[12] [4] [5]}
• Pheochromocytoma (often benign, sometimes malignant): arises in the adrenal medulla and produces catecholamines; it is a well-known cause of paroxysmal hypertension and orthostatic hypotension-related dizziness. ^{[14] [6] [7]}

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Practical evaluation when dizziness is present

• Blood pressure assessment: check for sustained hypertension, paroxysms, and orthostatic drops (lying-to-standing changes), as these patterns can point toward catecholamine or mineralocorticoid excess. ^{[6] [7]}
• Electrolytes: test potassium; low potassium suggests mineralocorticoid excess (aldosterone-like activity) that can occur in adrenal tumors, including rare cases of ACC. ^{[4] [5]}
• Blood glucose: screen for hyperglycemia, as cortisol excess can raise blood sugar and contribute to symptoms. ^{[2] [9]}
• Hormone testing: depending on clinical clues, measure cortisol (and consider Cushing workup), aldosterone/renin ratio, and catecholamine metabolites (plasma free metanephrines or urinary fractionated metanephrines) to differentiate tumor function. ^{[2] [12] [6]}
• Imaging: if biochemical testing suggests an adrenal source, adrenal imaging helps characterize the mass and guide management. Most adrenal tumors are benign, but functional status and imaging features inform treatment. ^{[1] [15]}

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When to seek urgent care

• Red flags: severe chest pain, shortness of breath, neurologic deficits, syncope (fainting), dangerously high blood pressure spikes, or confusion require urgent evaluation, as catecholamine surges or severe electrolyte disturbances can be life-threatening. Pheochromocytoma-related crises and malignant hypertension are medical emergencies. ^{[7] [16]}

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Bottom line

Adrenal cancer can be associated with dizziness, typically as a secondary effect of hormone overproduction (cortisol or, more rarely, aldosterone), blood pressure fluctuations, electrolyte abnormalities (especially low potassium), or catecholamine-related autonomic changes when the tumor type is pheochromocytoma. While most adrenal tumors are benign and often silent, any combination of resistant hypertension, hypokalemia, Cushing-like features, or paroxysmal symptoms should prompt targeted hormonal testing and imaging to clarify the cause and guide treatment. ^{[1] [2] [4] [5] [6] [7] [12] [9] [14] [13] [11] [10]}