Adrenal Disorders

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Adrenal Disorders

What are adrenal gland disorders?

Adrenal disorders can develop if your adrenal glands make too much or not enough of certain hormones, including hydrocortisone (called cortisol), adrenaline or aldosterone. These hormones keep metabolism, blood pressure, the immune system and stress response in balance. The adrenal glands are located on the top of each kidney. If adrenal gland disorders are not treated, serious complications can develop, including death.

Causes

What causes adrenal disorders?

The adrenal gland can be affected by different problems. Each type of adrenal disorder has somewhat different causes and symptoms. Some of the most common disorders include:

  • Addison’s disease is a rare disorder caused when the adrenal glands don’t make enough cortisol, or in most cases, enough aldosterone hormone. Addison’s is an autoimmune disease, meaning the immune system mistakenly attacks the body’s own cells and tissues. This reaction can damage the adrenal glands.
  • Adrenal gland suppression can occur when someone takes steroid medications (prednisone, hydrocortisone, dexamethasone), which act like cortisol in the body. If you are prescribed steroids, you would normally take gradually lower doses. If steroids are stopped suddenly, the adrenal glands may be unable to produce enough cortisol for several weeks or months, causing health problems.
  • Congenital adrenal hyperplasia (CAH) is a common genetic disorder that causes the cortisol level to be too low, and aldosterone and androgen hormone imbalances. Mild CAH may not cause symptoms and may never be diagnosed.
  • Cushing syndrome is a rare disease caused by having too much cortisol. It can develop due to long-term or overuse of steroids, or if the body produces too much cortisol. Cortisol overproduction can occur if there are tumors of the pituitary or adrenal glands, lung, pancreas or thyroid.
  • Hyperaldosteronism occurs when the body produces too much aldosterone. This hormone controls blood pressure and regulates salt and potassium levels. Extra aldosterone can be produced by a tumor on one or both adrenal glands, called hyperplasia.
  • Virilization can occur when the body produces too much of the male sex hormones. It’s only apparent in females or males before puberty.

If the adrenal gland develops tumors, these conditions can occur:

  • Adrenal gland tumors can disrupt hormone output, but are usually not cancerous. The tumors can produce different hormones and cause hormone levels to be too high. If the tumors produce too much cortisol, they can cause Cushing’s syndrome; primary hyperaldosteronism if they create too much aldosterone; and pheochromocytoma if they produce too much adrenaline.
  • Adrenocortical carcinoma is a rare, slow-growing cancer that forms on the outer layer of the adrenal gland.
  • Pheochromocytoma causes the glands to produce excess epinephrine and norepinephrine which can raise blood pressure or make the heart race.
  • Pituitary gland tumors are abnormal growths on the pituitary gland that cause a disruption in the amounts of hormones made by the adrenals, and causes hormone deficiency. They are not cancerous.
  • Pheochromocytoma and paraganglioma are rare tumors; 90% are noncancerous. Pheochromocytomas form in the adrenal glands, and paragangliomas form in cells of the neuronal origin, which is located throughout the neck, chest, abdomen and pelvis. Both types of tumors can produce hormones that control heart rate, blood pressure and the body’s stress reaction.

What is adrenal gland insufficiency?

Primary adrenal insufficiency can happen when the adrenal glands don’t produce enough cortisol or aldosterone. The cause is destruction of the adrenal glands’ outer layer, which can be caused by an autoimmune disease that attacks the glands, from tumors, or tuberculosis or other infections.

Secondary adrenal insufficiency is more common, and is caused when the pituitary gland doesn’t produce enough ACTH. If there’s insufficient ACTH, the adrenal glands don’t make enough cortisol. It’s most commonly caused when the patient has taken glucocorticoids (prednisone) for a long time and then stops too quickly, without tapering the dosage. It can also be caused by surgery or radiation to the pituitary gland, or by tumors in the pituitary gland.

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Symptoms

What are symptoms associated with adrenal disorders?

Adrenal disorders can cause a life-threatening medical emergency, due to a severe lack of cortisol. An adrenal crisis can cause:

  • Severe, rapid-onset pain in the lower body
  • Vomiting and diarrhea
  • Weakness
  • Confusion and loss of consciousness
  • Low blood glucose
  • Low blood pressure

Other adrenal conditions can cause these symptoms:

  • Addison’s disease symptoms vary, depending on the cause of the disease. If left untreated, the damage continues until the adrenal glands don’t work at all. The most common symptoms include weight loss, weakness and extreme fatigue, nausea or vomiting, low blood pressure and dizziness upon standing, patches of darker skin, craving for salt, and depression. 
  • Congenital adrenal hyperplasia (CAH) may not cause symptoms. If there are symptoms, they can include short height, early puberty, acne, irregular menstrual periods, difficulty getting pregnant, and excess facial hair in women. The severe type of CAH, diagnosed in children, can include: dehydration, low blood pressure, low glucose, trouble keeping enough salt in the body, short height, and early puberty. Females may have altered development of external genitalia, irregular periods, difficulty getting pregnant, and excess facial hair. Males may have non-cancerous testicular tumors and infertility. 
  • Cushing’s syndrome symptoms caused by tumors include upper body obesity but thin arms and legs, round face and neck, skin problems, high blood pressure, high glucose, muscle and bone weakness, moodiness, irritability, depression, and slow growth rates in children. Women may have hair growth on their face and body, and irregular periods. Men may become less fertile and have a low sex drive.
  • Hyperaldosteronism’s most common symptom is hard-to-control high blood pressure. Other symptoms include low potassium levels, muscle cramps or spasms, excessive urination, weakness, and headaches. 
  • Pituitary gland tumors, if too much prolactin is produced, can cause headaches and some vision loss. In women it can cause irregular menstrual periods, difficulty getting pregnant and production of breast milk in nonpregnant or non-breastfeeding women. In men it may cause impotence and a low sex drive. 
  • If pituitary gland tumors produce too much adrenocorticotropin (ACTH) symptoms can include: headaches; some vision loss; weight gain in the face, neck and torso; thin arms and legs; lump of fat on the back of the neck; thin skin with purple/pink stretch marks on the chest or abdomen; easy bruising; excess facial and body hair growth; easily broken bones; irregular menstrual periods; anxiety, irritability or depression; and slowed growth in children along with weight gain.
  • If pituitary gland tumors produce too much human growth hormone (HGH), symptoms may include: headaches; some vision loss; growth of bones in face, hands, and feet in adults; excessive growth of the whole body in children; tingling or numbness in hands; snoring or sleep apnea; joint pain; excessive sweating; and extreme dislike or concern about one or more body parts. 
  • If pituitary gland tumors produce too much thyroid-stimulating hormone (TSH), it may cause irregular heartbeat, shakiness, weight loss, sleep problems, frequent bowel movements, and sweating.
  • Nonfunctioning pituitary tumors can press on or damage your pituitary gland, keeping it from producing enough hormones. If hormones are insufficient, the gland or organ it normally controls won’t function properly. Nonfunctioning pituitary tumors can cause headaches, some vision loss, loss of body hair, and a lower sex drive. Women can have fewer menstrual periods and no breast milk after giving birth. Men may lose facial hair, be impotent and have growth of breast tissue. Children may have slowed growth and sexual development.
  • Pheochromocytoma or paraganglioma tumors can cause symptoms that include: high blood pressure (caused by overproduction of adrenaline or noradrenaline), rapid heart rate, headaches, sweating, anxiety or panic attacks, hand tremors, pale skin, blurred vision, weight loss, constipation, belly pain, high glucose, and psychiatric disturbances.
  • Virilization can happen to males before puberty or to females, resulting in the development of male characteristics, including facial hair and/or balding, acne, a deeper voice, increasing muscles, or developing a stronger sex drive.

Diagnosis

How are adrenal disorders diagnosed?

 Your doctor will take your medical history and ask about your symptoms.

  • Blood and urine tests are used to measure the amounts of adrenal hormones in your body, which can detect a functional adrenal tumor. A cortisol test is used to help diagnose disorders of the adrenal gland. To diagnose Addison's disease, blood tests that measure the levels of sodium, potassium and cortisol in your body will be used. 
  • Computer tomography (CT) scan or magnetic resonance imaging (MRI) can be used to diagnose adrenal gland tumors and determine if they’re cancerous. 

Contact your doctor right away if you have any of these common symptoms of adrenal disorders:

  • Losing weight without trying
  • Gaining weight in the upper body
  • Extreme exhaustion
  • Severe pain that doesn’t stop
  • Changes in hair growth
  • Easy bruising or developing stretch marks

What kind of doctor treats adrenal disorders?

Endocrinologists are medical doctors that specialize in diagnosing and treating adrenal disorders.

Treatment

What are the treatment options for adrenal disorders?

Treatment varies according to the type and cause of your adrenal disorder. In general, these treatments are available:

  • Surgery to remove tumors in the adrenal gland or remove one or both adrenal glands. Surgery is also used to remove pituitary tumors.
  • Medications are used to stop the excess production of hormones.
  • Hormone replacement medications are used to add the hormones the adrenal glands no longer produce. 
  • Radiation can be used in treating Cushing’s syndrome, in combination with medications and surgery.
  • Consuming extra salt is one part of the treatment for Addison’s disease.

References

Cleveland Clinic. (June 2021). Adrenal Disorders. Retrieved 7-23-21, {https://my.clevelandclinic.org/health/diseases/16717-adrenal-disorders}
National Institutes of Health. (Jan. 2017). What are Some types of Adrenal Gland Disorders? Retrieved 7-23-21, {https://www.nichd.nih.gov/health/topics/adrenalgland/conditioninfo/type
National Institutes of Health. (Jan. 2017). What are the Symptoms of Adrenal Gland Disorders? Retrieved 7-23-21, {https://www.nichd.nih.gov/health/topics/adrenalgland/conditioninfo/symptoms}
National Institutes of Health. (Jan. 2017). What are the Treatments for Adrenal Gland Disorders? Retrieved 7-23-21, {https://www.nichd.nih.gov/health/topics/adrenalgland/conditioninfo/treatment}

Information

Medically reviewed by:

Jodi B. Nagelberg, MD, MHA

Dr. Jodi Nagelberg is an endocrinologist, with board certification in Interal Medicine. She also holds a masters in Health Administration and Policy. She joins TeleMed2U as Endocrinology Director and supports our mission to increase access to healthcare for patients everywhere.Postgraduate: University of Southern California Sol Price School of Public Policy Los Angeles, CA Masters, Health Administration and Policy, 2011

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