Adrenal tumors in the elderly

The incidence of adrenal tumors rises with age, but the link between adrenal aging and tumorigenesis is still not well defined. This mini-review summarizes age-related changes in both the adrenal cortex and medulla, including structural remodeling, altered steroidogenesis, and shifts in immune and cellular homeostasis. We then examine adrenocortical carcinoma (ACC), where clinical outcomes are poorer in older patients and where senescence, inflammation, and sex-specific immune differences may shape disease behavior. Limited information is available for other adrenocortical tumors, while pheochromocytomas in the elderly are described mainly in case reports, often with diagnostic and perioperative difficulties. For other rare adrenal neoplasms, data are fragmentary. Much of the mechanistic evidence summarized here derives from preclinical models, and robust clinical validation remains limited; accordingly, translational inferences should be regarded as provisional. The evidence suggests that aging influences both the biology and clinical course of adrenal tumors, but systematic studies are lacking. This review brings together what is currently known and highlights many open questions. We hope this will serve as a starting point for further work on how aging affects adrenal function and tumor development and how this knowledge might be used to improve care of older patients.