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When Darrell Borum was in his mid-30s in the early 2000s, he began experiencing symptoms that initially sent him to see a cardiologist.

“I had high blood pressure and a rapid heart rate, more than 120 beats per minute,” Borum remembered. “But my cardiologist did not think it was cardiac in nature.”

It wasn’t until 2013 that a CT scan for an unrelated gall bladder infection also detected the cause of Borum’s symptoms: a nodule on his left adrenal gland.

“Incidental adrenal nodules are identified in about 5-10% of abdominal CT scans,” said Amelia Grover, M.D., FACS, a surgical oncologist at VCU Massey Comprehensive Cancer Center. “The problem is that many of them are not evaluated properly and place the patient at risk from complications secondary to hormonal overproduction or a missed adrenal cortical cancer, which affects one to two of every one million people. As a rare malignancy, it is often caught late, and there are not a lot of treatments because of its infrequency. If caught early, it can be curable, and that is why the appropriate workup of an adrenal nodule is so important.”

The nodule on Borum’s adrenal gland contributed to the release of higher-than-normal amounts of aldosterone, a hormone that regulates the balance of salt and water in the body and the excretion of potassium by the kidneys. According to Grover, who is also a professor at the VCU School of Medicine and director of the Endocrine Tumor Multidisciplinary Program, about 30% of cases of this hyperplasia are caused by increased levels of aldosterone, which plays an important role in regulating blood pressure.

For more than five years, doctors monitored Borum’s adrenal hyperplasia and treated it with regular potassium infusions. Borum then made the decision to have his left adrenal gland surgically removed in Dec. 2018.

“I am and cannot stress enough how thankful I am that Dr. Grover and Domenic Sica, M.D., [a now-retired nephrologist], encouraged me to have the surgery,” Borum said. “Other doctors I saw prior to the two of them were hesitant to recommend it.”

Grover said Borum’s condition occurs in 5-15% of the population and is diagnosed more frequently in hypertensive patients; it often takes some time for these patients to receive a clear diagnosis and the treatment they need.

“While it is not a cancer, the disease leads to significant cardiovascular risk and stroke risk over time and why it is so important to recognize it and treat it,” Grover explained. “Mr. Borum was able to have surgery by a minimally invasive approach, which allowed him to leave the hospital in one to two days. Having the care team with Dr. Sica being a hypertensive specialist was so important in his care because having better control of his blood pressure around surgery decreases his risks. Between our cardiology team, our endocrinologists and anesthesiologists, we have the expertise at VCU to take care of these patients before, during and after their surgery safely.”

Borum lost 35 pounds within a few months of the surgery from no longer retaining high levels of sodium. Now, more than five years since the removal of his left adrenal gland, Borum does not receive any treatment for the condition.

“I had my one and only visit to Massey, the Dalton Oncology Clinic. Professional people there,” Borum remembered. “I’m much, much better. Just being able to go out to restaurants, work and stores; that we all take for granted.”

Borum is sharing his Massey story in the hopes that other individuals with adrenal gland nodules will explore their options for any and all of their symptoms.

“In addition, adrenal cancer can be related to a genetic problem in about 50% of cases, which is important since that can affect other family members,” Grover explained why it is crucial to be proactive when a nodule is detected.

Borum recalls that he initially chose Massey because of the center’s specialty in adrenal care, but the now 55-year-old recognizes that he gained much more from his experience.

“I have slight cerebral palsy, and I cannot say enough about the excellent care I got. Dr. Grover is a top-notch surgeon,” Borum said.

He added, “I would not be alive today had I not had the surgery. I thank Dr. Grover profusely [and the whole team for] taking a true interest in me.”

Written by: Amy Lacey