Adrenal Cancer and Skin Changes: What to Know

Skin rash is not a classic hallmark of adrenal cancer itself, but adrenal tumors especially adrenocortical carcinoma can cause hormone imbalances that lead to noticeable changes in the skin. These skin changes typically arise from excess cortisol (Cushing syndrome) or, less commonly, excess sex hormones, rather than from the cancer directly infiltrating the skin. ^[1] Skin rashes can also occur as side effects of certain treatments for adrenal cortical carcinoma, such as chemotherapy combinations and mitotane. ^[2]

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How Adrenal Cancer Affects the Skin

• Hormone overproduction and skin changes: Many adrenal cortical cancers produce extra hormones, most often cortisol, causing Cushing syndrome with characteristic skin findings. ^[1] In Cushing syndrome, common skin features include pink or purple stretch marks (striae), easy bruising, thin, fragile skin, acne, and slow wound healing. ^[3] These changes are a consequence of prolonged high cortisol levels, which weaken skin structure and affect blood vessels. ^[4]

• “Unusual skin changes”: Clinical summaries of adrenocortical carcinoma list “unusual skin changes” among possible symptoms, reflecting the hormone-driven skin manifestations rather than a single specific rash pattern. ^[5] This phrasing underscores that skin findings vary and are often hormonal in origin. ^[6]

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Specific Skin Findings Linked to Cushing Syndrome

• Striae (stretch marks): Often wide and pink to purple, typically on the abdomen, hips, thighs, breasts, and underarms. ^[3] These striae are broader than common stretch marks due to the skin-thinning effects of cortisol. ^[4]

• Easy bruising and thin skin: Cortisol makes the skin thin and fragile, so bruising can happen with minor bumps and injuries. ^[3] This is frequently noticed on the arms and hands. ^[4]

• Acne and infections: Acne and recurrent skin infections may occur because cortisol alters immune responses and skin oil production. ^[4] These features may coincide with other signs like facial rounding (“moon face”) and a fat pad between the shoulders (“buffalo hump”). ^[3]

• Slow wound healing: Cuts and scrapes can take longer to heal due to cortisol’s effects on collagen and immunity. ^[3]

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Less Common Skin Changes

• Excess hair growth (hirsutism): When adrenal tumors produce sex hormones (androgens), women may notice thick, dark hair on the face and body, and menstrual changes. ^[7] While not a rash, it is a visible skin-related change that can point to hormonal activity. ^[1]

• Hyperpigmentation or darkening: Some patients report skin color changes or darkening during certain chemotherapy regimens used for advanced adrenocortical carcinoma. ^[8] This is a treatment-related effect, not a hallmark of the tumor itself. ^[2]

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Are Skin Rashes a Symptom of Adrenal Cancer?

• Primary cancer symptom vs. treatment effect: A typical “rash” is not a primary or defining symptom of adrenal cortical carcinoma. ^[1] However, rashes can occur during treatment, with reports of red, bumpy, itchy skin and general dryness; these are managed with moisturizers, sun protection, and medical guidance. ^[2]

• Paraneoplastic skin syndromes: While various internal cancers can cause indirect, immune-mediated skin conditions (paraneoplastic dermatoses), adrenal cortical carcinoma is more commonly associated with hormone-driven skin changes rather than specific paraneoplastic rashes. ^[9] The skin findings that raise suspicion in adrenal tumors tend to align with Cushing syndrome features rather than distinctive paraneoplastic patterns. ^[1]

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Quick Reference: Common Skin Changes in Adrenal Cancer (Hormonal)

Skin Change	Typical Appearance	Why It Happens	Common in Adrenal Cancer?
Purple/pink striae	Wide stretch marks on abdomen, hips, thighs, breasts, underarms	Cortisol thins skin and weakens collagen	Yes (Cushing syndrome) [3] [4]
Easy bruising	Bruises with minor trauma, thin fragile skin	Cortisol affects vessel integrity and skin thickness	Yes (Cushing syndrome) [3] [4]
Acne	Pimples, oily skin	Hormonal imbalance (cortisol, androgens)	Yes (Cushing syndrome/androgens) [3] [4]
Slow wound healing	Prolonged healing of cuts	Cortisol inhibits collagen and immune response	Yes (Cushing syndrome) [3]
Hirsutism	Dark, coarse hair on face/body (women)	Excess androgens from tumor	Sometimes (androgen-producing tumors) [7] [1]
General “unusual skin changes”	Variable, not one specific rash	Hormone excess	Reported in ACC summaries [5] [6]
Treatment‑related rash	Red, bumpy, itchy, dry skin	Chemo/mitotane side effects	Possible during therapy [2]
Skin darkening	Darker skin in sun‑exposed areas; darkening of tongue/gums	Certain chemotherapy effects	Possible during therapy [8]

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When to Seek Medical Advice

• Persistent or worsening skin changes: If you notice new, wide purple striae, easy bruising, thinning skin, or acne with other signs like weight gain in the trunk, round facial appearance, or elevated blood pressure and blood sugar, these may be consistent with Cushing syndrome and merit prompt evaluation. ^[1] These constellation symptoms suggest hormone excess more than a simple rash. ^[3]

• During treatment: If you are receiving therapy for adrenocortical carcinoma and develop rash, dryness, or darkening of skin, let your care team know; adjustments and supportive care can help manage these effects. ^[2] Protecting the skin from sun exposure and using gentle moisturizers are commonly recommended. ^[2]

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Key Takeaways

• A classic “skin rash” is not a core symptom of adrenal cancer. Skin changes in adrenal cortical carcinoma mainly reflect hormone excess, especially cortisol, leading to purple striae, easy bruising, thin skin, acne, and slow wound healing. ^{[1] [3]}

• Treatments for adrenal cancer can cause rashes and skin darkening, which should be managed with supportive skin care and medical follow-up. ^{[2] [8]}

• If you observe these skin changes alongside other features of Cushing syndrome, medical assessment is advisable to evaluate adrenal hormone levels and overall health. ^[3]