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Should an adrenal tumor be biopsied?

One common mistake is to perform a biopsy when an adrenal tumor is discovered. This can be disastrous if the tumor is a pheochromocytoma. Adrenal masses should never be biopsied unless a pheochromocytoma has been ruled out with biochemical tests. Even then, a biopsy is rarely helpful or necessary. The main reason to biopsy an adrenal mass is to make a diagnosis of an adrenal metastasis in someone with another type of cancer for whom the physician is deciding between systemic therapy and surgery. An example of this is someone with lung cancer and an adrenal tumor. If the adrenal tumor is a metastatic lung cancer, the patient will likely get chemotherapy and not an operation to remove the lung cancer. 
Ajay K. Sahajpal, MD
Transplant Surgery
No. In general, an adrenal tumor should not be biopsied until a full hormonal/biochemical or functional work up has been done by either the endocrinologist, surgeon or primary MD. If a diagnosis can't be made after that and it is clear that the tumor is not functional or producing hormones than a multidisciplinary tumor board can discuss a biopsy.
Steven G. Eisenberg, DO
Hematology & Oncology

The cells obtained by a needle biopsy of an adrenal tumor CANNOT tell the pathologist whether the tumor is a benign adrenal mass or a rare adrenal carcinoma. It will only help in determining a primary adrenal tumor (started in the adrenal) versus metastatic tumor (one that traveled to the adrenal gland). Most commonly, a biopsy is done if there is evidence of cancer outside the adrenal gland, or a patient with a known cancer (such as lung cancer) has a suspicious adrenal mass. We must also exclude a pheochromocytoma with biochemical testing prior to a biopsy.

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