Can Adrenal Cancer Cause Nausea?

Yes, adrenal cancer (particularly adrenocortical carcinoma and pheochromocytoma) can be associated with nausea in some people, and this symptom may arise for several reasons related to hormone excess, tumor size and local pressure, treatment side effects, and metastatic spread. ^{[1] [2]}

---

How Nausea Can Occur in Adrenal Cancer

• Local pressure from a growing tumor: As an adrenal tumor enlarges, it can press on nearby organs in the upper abdomen, leading to abdominal discomfort, a sense of fullness, bloating, indigestion, and sometimes nausea. ^{[3] [2]} This “mass effect” is more likely when tumors are large or invasive. ^[3]

• Hormone overproduction (functional tumors): Many adrenal cancers secrete excess hormones, and these biochemical changes can trigger gastrointestinal symptoms.

  • Excess cortisol (Cushing syndrome) often causes broad systemic effects; while classic signs include weight gain, muscle weakness, and high blood pressure, patients may also experience abdominal complaints that contribute to nausea. ^{[4] [5]}
  • Excess catecholamines (pheochromocytoma) can cause episodic surges with headache, palpitations, sweating, abdominal pain, and notably nausea and vomiting sometimes triggered by exertion or stress. ^{[6] [7]}
  • Aldosterone excess (Conn’s syndrome) leads to low potassium, which can cause weakness and gastrointestinal symptoms; bloating and fluid retention may also worsen abdominal discomfort. ^[8]

• Advanced disease and nonspecific symptoms: In some cases, adrenal cortical carcinoma is first detected during workups for nonspecific complaints such as abdominal pain and nausea, reflecting either mass effect or systemic illness. ^[1]

• Treatment-related causes: Chemotherapy regimens used for adrenal tumors (for example, doxorubicin, cisplatin, etoposide) commonly cause nausea and vomiting as side effects. ^[9] Additionally, mitotane a cornerstone drug for adrenocortical carcinoma can produce gastrointestinal intolerance in some patients, contributing to persistent nausea if not carefully managed. ^{[10] [11]}

---

Mechanisms Behind Nausea

• Adrenergic activation: In pheochromocytoma, bursts of catecholamines can directly stimulate brain regions that trigger vomiting (the area postrema), explaining exercise‑induced or stress‑related nausea and vomiting observed in a subset of patients. ^[7]

• Gastrointestinal motility changes: Hormonal imbalances (cortisol, catecholamines, aldosterone) can alter gut motility, acid secretion, and electrolyte balance, contributing to dyspepsia, indigestion, and nausea. ^{[4] [6]} Excess cortisol also promotes systemic metabolic disturbances and can aggravate GI symptoms in susceptible individuals. ^[5]

• Physical compression: Large adrenal masses can compress the stomach, duodenum, or pancreas region, causing fullness, early satiety, indigestion, and nausea. ^{[3] [2]}

• Chemotherapy emetogenicity: Agents used in adrenal tumor protocols have well‑recognized emetogenic potential, leading to acute and delayed nausea/vomiting unless prophylactic antiemetics are used. ^[9]

---

Typical Symptom Patterns

• Adrenocortical carcinoma (ACC): Around 60% of ACCs present with hormone excess, most commonly cortisol (Cushing syndrome), while others present with abdominal discomfort or nonspecific symptoms such as nausea. ^[1] Mass effect can produce abdominal pain, fullness, bloating, and indigestion. ^[2] Cushing features include weight gain and hypertension; GI complaints may coexist. ^{[4] [5]}

• Pheochromocytoma (adrenal medullary tumor): Paroxysmal episodes may include headache, palpitations, sweating, abdominal pain, and nausea/vomiting; emesis is a recognized and sometimes initial complaint, including exercise‑induced nausea/vomiting that resolves after tumor removal. ^{[6] [12] [7]}

---

When to Seek Evaluation

• Persistent or unexplained nausea with abdominal pain, fullness, or episodes of sweating, palpitations, and headaches especially if accompanied by high blood pressure warrants evaluation for adrenal disease. ^[6] Screening may involve hormone testing (cortisol, metanephrines) and imaging (CT/MRI). ^[13] If an adrenal mass is found, clinicians assess whether it is functional (secreting hormones) and determine malignancy risk. ^[13]

---

Management and Symptom Control

• Treat the underlying tumor: Surgical removal is the mainstay for localized functional adrenal tumors and many ACCs; controlling hormone excess can reduce GI symptoms. ^[13] In ACC, mitotane and combinations with chemotherapy are used when surgery is not feasible or for metastatic disease. ^{[1] [10] [11]}

• Control hormones: Steroidogenesis inhibitors (mitotane, ketoconazole, metyrapone, etomidate) may be used to reduce cortisol excess and improve systemic symptoms. ^{[10] [11]} In pheochromocytoma, alpha‑ and beta‑blockade precede surgery to stabilize catecholamine effects and reduce paroxysmal symptoms including nausea. ^[6]

• Manage chemotherapy‑related nausea: Antiemetic regimens (e.g., 5‑HT3 antagonists, NK1 antagonists, dexamethasone where appropriate) are commonly prescribed to prevent or treat treatment‑induced nausea and vomiting. ^[9]

---

Key Takeaways

• Nausea can occur in adrenal cancer due to hormone excess, mass effect from a growing tumor, nonspecific systemic illness, treatment side effects, or metastatic involvement. ^{[1] [2]}
• Pheochromocytoma commonly features nausea/vomiting, sometimes exercise‑induced, via catecholamine surges. ^{[6] [7]}
• Evaluation includes hormone testing and imaging, and symptom relief typically follows control of the tumor and its hormonal activity, plus targeted antiemetic support when needed. ^{[13] [10] [9]}