Adrenal glands: quick fire questions

Leading consultant paediatric endocrinologist and consultant paediatrician Professor Sze May Ng OBE answers your quick-fire questions about adrenal glands, including the causes of adrenal glands disorders, and how they can be treated.

What are adrenal glands?

Adrenal glands are super renal glands situated above the kidneys, and are responsible for producing cortisol and aldosterone. Adrenal disorders often involve adrenal insufficiency, a rare condition characterised by inadequate production of these hormones. This disorder is rare, affecting an estimated 100 to 150 people per million, with an incidence rate of 5 to 6 per million per year. The adrenal glands are essential because they produce cortisol, a vital hormone for various bodily functions.

Why is the hormone cortisol important?

The hormone cortisol is important because it helps the body to respond to stress such as illness and infection, as well as when undergoing surgery. Cortisol helps to maintain blood pressure, blood sugar levels, and cardiovascular function, It also works to regulate the body's metabolism.

What is the importance of the hormone aldosterone?

The hormone aldosterone is crucial for regulating the balance of salt and water in the body. Additionally, it helps to also regulate blood pressure.

What are the causes of adrenal disorders and adrenal insufficiency?

The causes of adrenal insufficiency can be classified as primary, secondary, or due to chronic cortisol exposure. Primary adrenal insufficiency, commonly known as Addison's disease, occurs when the adrenal glands fail to produce enough cortisol. This can result from infections, bleeding into the glands, tumours, or autoimmune processes.

Secondary adrenal insufficiency happens when the pituitary gland fails to produce adequate Adrenocorticotropic Hormone (ACTH), which signals the adrenal glands to produce cortisol. Without enough ACTH, cortisol production drops. This can be caused by infections, pituitary tumours, congenital hypopituitarism from birth, or complications from surgery.

The third cause of adrenal insufficiency is prolonged exposure to high levels of cortisol, such as from taking steroid medications (orally or topically) for conditions like autoimmune diseases, cancer, or severe asthma. This prolonged exposure can suppress the adrenal glands, leading to reduced production of the body's own cortisol and resulting in adrenal insufficiency.

What investigations would be required?

The typical investigations a GP or clinician might conduct include measuring early morning plasma or blood cortisol levels. This serves as a screening test. The gold standard test, often requiring a short hospital admission, is the hormone dynamic function test known as the synacthen test.

What are treatment options?

Treatment for all forms of adrenal insufficiency typically involves hormone replacement therapy. This includes medications like hydrocortisone to replace cortisol and fludrocortisone to replace aldosterone. Specialists may prescribe different types of cortisol preparations based on the specific needs of the patient.

Treatments for all forms of adrenal insufficiency is generally replacement of the hormones made by the adrenal glands such as hydrocortisone medications to replace cortisol or fludrocortisone medications to replace aldosterone and there are different types of cortisol preparations that can be prescribed by the specialist.

What are the signs of adrenal disorders, Addison’s disease or adrenal insufficiency?

The signs of adrenal insufficiency can develop slowly over months. These signs may include  extreme tiredness and unexplained weight loss, reduced appetite, darkening of the skin (hyperpigmentation), low blood pressure, low blood sugars, and in some cases, abnormal menstrual periods.

If you have any concerns about adrenal glands and would like to book a consultation with Professor Ng, you can do so by visiting her Top Doctors profile today.