Adrenal tumours are increasingly identified in ageing populations, yet the biological links between adrenal ageing and tumour behaviour remain incompletely understood. In this review, Decmann et al. have brought together clinical observations and molecular and immunological insights, to examine how ageing reshapes the adrenal gland and influences neoplastic disease.

The authors describe age-related changes in the adrenal cortex and medulla, including cortical thinning, focal hyperplasia, altered steroidogenesis and immune infiltration. They discuss how these processes create a biological context in which adrenal nodules and tumours may emerge. The review then focuses on adrenocortical carcinoma (ACC), highlighting consistently poorer outcomes in older adults, and synthesising recent experimental evidence implicating cellular senescence, inflammation and sex-specific immune responses in disease evolution. Notably, senescence-associated mechanisms are presented as having context-dependent effects, with early tumour-suppressive roles that may later give way to pro-tumorigenic signalling and metastatic potential.

Beyond ACC, the review draws attention to the limited and fragmented evidence base for other adrenal tumours, including functional adenomas and phaeochromocytomas, particularly in older patients. By framing adrenal neoplasia through the biology of ageing rather than age alone, this article offers a compelling perspective for both clinicians and researchers.

Read the full article in Endocrine-Related Cancer https://doi.org/10.1530/ERC-25-0150