What initial investigations should I perform for a patient with suspected adrenal cancer presenting with symptoms such as abdominal pain or weight los

For a patient with suspected adrenal cancer presenting with symptoms such as abdominal pain or weight loss, initial investigations should include urgent imaging, preferably a CT scan of the abdomen, to identify adrenal masses and assess local invasion or metastases. Additionally, biochemical tests to evaluate adrenal hormone excess (such as cortisol, aldosterone, and catecholamines) should be considered to assess functional status of the tumour. Given the nonspecific symptoms like weight loss and abdominal pain, a thorough assessment for other possible cancers should also be performed, including blood tests and imaging as clinically indicated. Referral via a suspected cancer pathway is recommended for urgent investigation and specialist assessment.

While the provided UK guidelines do not specify adrenal cancer investigations explicitly, they recommend urgent imaging such as CT scans for patients aged 60 and over with weight loss and abdominal pain to investigate possible pancreatic or other intra-abdominal cancers, which is applicable to adrenal masses as well. Biochemical evaluation is standard clinical practice for adrenal tumours but is not detailed in the NG12 guideline.

Summary of initial investigations:

• Urgent CT scan of the abdomen to detect adrenal mass and staging ¹
• Biochemical tests for adrenal hormone excess (cortisol, aldosterone, catecholamines) to assess tumour functionality (clinical standard)
• Assessment for other symptoms/signs to guide further investigations or referrals ¹
• Referral via suspected cancer pathway for urgent specialist assessment ¹