Adrenal Dysfunction

Overview

The adrenal glands are two small, triangular glands that sit on top of the kidneys. Despite their size, they produce hormones essential to life, including cortisol (which helps the body handle stress and regulate blood sugar), aldosterone (which controls salt, fluid, and blood pressure), and adrenaline. Adrenal dysfunction is a broad term for any problem in which these glands make too little or too much hormone.

When the glands underproduce, the result is adrenal insufficiency, which leaves the body unable to cope with stress and illness. When they overproduce, conditions such as excess cortisol or excess aldosterone develop. Because adrenal hormones affect so many systems, symptoms can be wide-ranging and easy to miss, but most forms can be diagnosed with blood tests and managed effectively.

Symptoms

Symptoms depend on which hormones are out of balance and whether they are too high or too low.

• Too little hormone (insufficiency): fatigue, weakness, weight loss, poor appetite, low blood pressure, dizziness on standing, salt craving, nausea, and darkening of the skin in some cases
• Too much cortisol: weight gain around the trunk and face, easy bruising, high blood pressure, high blood sugar, muscle weakness, and mood changes
• Too much aldosterone: high blood pressure, headache, muscle cramps, and low potassium

A sudden, severe worsening of insufficiency, called an adrenal crisis, can cause vomiting, confusion, severe weakness, and dangerously low blood pressure. This is a medical emergency.

Causes

Different conditions disturb adrenal hormone production in different ways:

• Autoimmune damage: The most common cause of primary adrenal insufficiency (Addison disease), where the immune system attacks the glands.
• Pituitary problems: The pituitary gland in the brain controls the adrenals; if it underfunctions, the adrenals receive too little signal.
• Stopping steroid medicine suddenly: Long-term steroid pills can suppress the glands, so abruptly stopping them can trigger insufficiency.
• Adrenal tumors or overgrowth: Non-cancerous or, rarely, cancerous growths can cause overproduction of cortisol or aldosterone.
• Genetic conditions: Such as congenital adrenal hyperplasia, which alters hormone production from birth.

Risk Factors

• Other autoimmune diseases, such as type 1 diabetes or thyroid disease
• Long-term use of steroid (corticosteroid) medicines
• A pituitary gland tumor or prior pituitary surgery or radiation
• A family history of adrenal or hormone disorders
• Certain infections that can affect the adrenal glands

Diagnosis

Diagnosis combines symptoms with blood and imaging tests to pinpoint which hormone is abnormal and why:

• Blood tests: to measure cortisol, aldosterone, and the pituitary hormone (ACTH) that stimulates the adrenals, along with sodium and potassium levels
• Stimulation test: measuring how cortisol responds to an injection that should make the glands work, used to confirm insufficiency
• Suppression test: checking whether cortisol falls as expected, used to investigate overproduction
• Imaging: CT or MRI scans of the adrenal glands or pituitary to look for tumors or other changes

Treatment

Treatment aims to restore a normal hormone balance and is usually overseen by an endocrinologist.

• Hormone replacement: For insufficiency, daily steroid medicine replaces missing cortisol, and sometimes a second medicine replaces aldosterone. Doses are increased during illness, injury, or surgery to mimic the body's natural stress response.
• Treating overproduction: Medicines that lower hormone levels, or surgery to remove an adrenal tumor or overactive gland.
• Emergency care: An adrenal crisis is treated urgently with injectable steroids and fluids. People with insufficiency are usually given an emergency injection kit and a medical alert bracelet.

With proper treatment and dose adjustments during stress, most people with adrenal dysfunction lead full, active lives.

Prevention

Many causes cannot be prevented, but complications can be avoided:

• Never stop long-term steroid medicine suddenly; reduce it only under medical guidance
• If you have adrenal insufficiency, learn to increase your steroid dose during illness or injury and carry an emergency injection
• Wear a medical alert bracelet so emergency staff know about your condition
• Keep regular follow-up appointments to fine-tune hormone doses

When to See a Doctor

See a doctor if you have ongoing fatigue, unexplained weight changes, persistent low or high blood pressure, salt cravings, or darkening of the skin. Call emergency services or go to the nearest emergency department right away if you or someone with known adrenal insufficiency develops severe weakness, repeated vomiting, confusion, or collapse, as this may be an adrenal crisis that requires immediate steroid treatment.

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. Addison's disease — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Adrenal gland disorders.
4. Endocrine Society. Adrenal Hormones.