Adrenal tumor microenvironment: hormone–immune crosstalk, molecular heterogeneity, and immunotherapeutic opportunities

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Adrenal tumors range from benign adenomas to aggressive adrenocortical carcinoma, exhibiting significant clinical and biological heterogeneity.
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The adrenal tumor microenvironment is characterized by interactions between hormone secretion and immune responses, influencing tumor behavior and treatment response.
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Distinct immune-stromal states are observed across adrenal tumor subtypes, with specific immune profiles linked to tumor characteristics and hormone production.
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Cortisol-producing tumors create an immunosuppressive environment, while catecholamine secretion in pheochromocytomas alters local metabolism and immune activity.
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Current evidence supports the need for classifying adrenal tumors by their endocrine-immune microenvironmental states to guide biomarker development and therapy.

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