Adrenal Disorders

Overview

The adrenal glands are two small, triangle-shaped glands that sit on top of each kidney. Despite their size, they produce hormones essential for life, including cortisol (which helps the body handle stress and regulate metabolism), aldosterone (which controls blood pressure and salt balance), and adrenaline (which drives the fight-or-flight response). They also make small amounts of sex hormones.

Adrenal disorders occur when these glands make too much or too little of one or more hormones, or when tumors develop in or above the glands. Because adrenal hormones touch so many body systems, symptoms can be wide-ranging and are sometimes mistaken for other conditions. Most adrenal disorders can be effectively managed once identified.

Symptoms

Symptoms depend on which hormone is affected and whether levels are too high or too low. Common patterns include:

• Too much cortisol (Cushing syndrome): Weight gain around the trunk and face, easy bruising, purple stretch marks, high blood pressure, and muscle weakness.
• Too little cortisol (adrenal insufficiency or Addison disease): Fatigue, weight loss, low blood pressure, salt cravings, and darkening of the skin.
• Too much aldosterone: High blood pressure that is hard to control and low potassium.
• Too much adrenaline (pheochromocytoma): Episodes of pounding heartbeat, sweating, headache, and spikes in blood pressure.

Causes

Different adrenal disorders have different causes:

• Cushing syndrome: Often caused by long-term steroid medication, or by a tumor in the pituitary or adrenal gland that drives excess cortisol.
• Addison disease: Usually an autoimmune attack on the adrenal glands; sometimes infections or other damage.
• Pheochromocytoma: A usually noncancerous tumor of the adrenal core that overproduces adrenaline-like hormones.
• Congenital adrenal hyperplasia: An inherited enzyme deficiency present from birth.
• Adrenal tumors: Growths, most of which are benign and hormonally inactive.

Risk Factors

• Long-term use of corticosteroid medications
• Other autoimmune conditions, such as type 1 diabetes or thyroid disease
• A family history of adrenal or endocrine disorders
• Certain inherited genetic syndromes
• Existing high blood pressure that is difficult to control

Diagnosis

Diagnosing adrenal disorders involves measuring hormone levels and looking for the cause:

• Blood and urine tests: To measure cortisol, aldosterone, adrenaline-related substances, and related pituitary hormones.
• Stimulation or suppression tests: Special tests that check how the glands respond to triggers, helping confirm over- or underactivity.
• Imaging: CT or MRI scans of the adrenal glands and pituitary to find tumors or other changes.

Treatment

Treatment depends on the specific disorder:

• Hormone replacement: For adrenal insufficiency, daily cortisol and sometimes aldosterone replacement restores normal levels.
• Lowering excess hormones: Medications, and often surgery, to remove tumors causing overproduction.
• Adjusting steroids: Carefully tapering steroid medication when it is the cause of excess cortisol.
• Surgery: Removing an affected adrenal gland or a pituitary tumor when needed.

People with adrenal insufficiency need a plan for increasing their hormone doses during illness, surgery, or major stress to avoid a life-threatening adrenal crisis.

Prevention

Most adrenal disorders cannot be prevented, but some risks can be reduced:

• Use corticosteroid medications only as prescribed and never stop them abruptly without medical advice
• Carry medical identification if you have adrenal insufficiency
• Keep regular follow-up appointments to monitor hormone levels
• Learn the warning signs of an adrenal crisis if you are at risk

When to See a Doctor

See a doctor for unexplained fatigue, weight changes, persistent high blood pressure, or episodes of pounding heartbeat with sweating and headache. Seek emergency care immediately if someone with known adrenal insufficiency develops severe weakness, vomiting, confusion, severe abdominal or back pain, or collapses; this may be an adrenal crisis, which is life-threatening and needs urgent treatment with intravenous steroids and fluids.

Related Topics

Frequently Asked Questions

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Adrenal Insufficiency & Addison's Disease.
2. Mayo Clinic. Adrenal glands and adrenal disorders.
3. Endocrine Society. Adrenal disorders.
4. MedlinePlus, U.S. National Library of Medicine. Adrenal gland disorders.