Is Unexplained Weight Gain a Symptom of Adrenal Cancer?

Unexplained weight gain can be a symptom of adrenal cancer, especially when the tumor produces excess cortisol leading to a condition called Cushing syndrome. ^[1] When adrenal cancer cells make too much cortisol, people may notice rapid or central weight gain, muscle weakness, purple stretch marks, easy bruising, high blood pressure, and high blood sugar. ^[1] In some adrenal tumors, abdominal obesity with thinning of the arms and legs, rounding of the face, and unexplained weight gain are typical features of hormone overproduction. ^{[2] [3]}

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How Adrenal Cancer Causes Weight Gain

• Hormone overproduction (cortisol): Many adrenal cancers secrete cortisol, which shifts fat to the trunk and upper back, causing central obesity and a “moon face,” even as arms and legs become thinner. ^{[1] [3]}
• Fluid retention: Some adrenal cortical carcinomas are associated with fluid retention and bloating, which can add to apparent weight gain. ^[4]
• Metabolic changes: Cortisol raises blood sugar and affects how the body stores fat, contributing to progressive weight gain and insulin resistance. ^[1]

In clinical practice, Cushing syndrome is the most frequent hormonal manifestation of adrenocortical carcinoma, and weight gain is one of its hallmark features. ^{[5] [6]}

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Not All Adrenal Cancers Cause Weight Gain

While many cases do show hormone-driven weight gain, not every adrenal cancer does:

• Non-functioning tumors: Some adrenal cancers do not produce hormones and instead present with abdominal pain, a palpable mass, or incidental findings on imaging; these may be associated with weight loss rather than gain. ^[7]
• Mass effect symptoms: Large tumors can cause abdominal fullness or pain without hormonal signs. ^[7]
• Variable presentations: A significant proportion of cases are discovered incidentally and may not show classic Cushing features. ^[5]

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Other Symptoms to Watch For

If weight gain is due to cortisol excess from adrenal cancer, other common signs often appear together:

• Muscle weakness and fatigue. ^[1]
• Pink or purple stretch marks (striae) on the abdomen or thighs. ^[1]
• Easy bruising with minor injury. ^[1]
• High blood pressure and high blood sugar/diabetes. ^[1]
• Rounded face and fat accumulation around the midsection with thinner limbs. ^{[3] [1]}
• Excess hair growth or skin changes (depending on other hormones produced). ^[4]

When these features cluster with unexplained weight gain, clinicians often consider cortisol-producing adrenal tumors in the differential diagnosis. ^{[2] [1]}

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When to Seek Evaluation

Unexplained, progressive weight gain especially central gain combined with features like purple stretch marks, easy bruising, muscle weakness, and high blood pressure should prompt medical evaluation for possible Cushing syndrome. ^[1] Because adrenal cancer is rare but can be aggressive, early recognition of hormone excess helps guide testing and treatment. ^[5]

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Diagnostic Approach

A thorough work-up typically includes:

• Hormone testing: Blood and urine tests to measure cortisol and related hormones to confirm Cushing syndrome. ^[3]
• Imaging: CT or MRI of the adrenal glands to identify a mass and assess size and spread. ^{[8] [7]}
• Specialized evaluation: Endocrine and oncologic assessment to determine whether a tumor is hormone-producing and whether it is likely malignant. ^[5]

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Treatment Overview

Management depends on tumor type and stage:

• Surgery: Complete surgical removal is the primary treatment when feasible. ^{[8] [7]}
• Mitotane and chemotherapy: For unresectable or metastatic disease, mitotane (a steroidogenesis inhibitor) often combined with chemotherapy can control hormone excess and reduce tumor burden. ^{[6] [9]}
• Aggressive control of cortisol: Controlling cortisol is crucial to reduce complications of Cushing syndrome; medications like mitotane, ketoconazole, metyrapone, or etomidate may be used to manage hormone levels. ^[9]

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Key Takeaways

• Yes, unexplained weight gain can be a symptom of adrenal cancer, mainly when cortisol is overproduced, causing Cushing syndrome. ^[1]
• Classic features accompanying weight gain include central obesity, muscle weakness, purple stretch marks, easy bruising, high blood pressure, and high blood sugar. ^{[1] [3]}
• Not all adrenal cancers cause weight gain non-functioning tumors may present differently, and some cases show weight loss or nonspecific abdominal symptoms. ^{[7] [5]}
• Early evaluation with hormone testing and imaging is important if Cushing-like signs accompany unexplained weight gain. ^{[3] [8]}