The hidden impact of adrenal gland disorders

Perched atop our kidneys like small but vital organs, the adrenal glands play a pivotal role in regulating the intricate balance of hormones and bodily functions. However, when these small but mighty glands fall out of balance, they can wreak havoc on our health. In his latest online article, Dr Kaustubh Nisal embarks on a journey through the complexities of adrenal gland disorders, exploring their manifestations, diagnostic challenges, and the evolving landscape of treatment options.

Understanding the adrenal glands:

Before delving into disorders, it's crucial to grasp the adrenal glands' primary roles. These small glands produce hormones essential for regulating metabolism, immune response, blood pressure, stress response, and other critical functions. The adrenal cortex, the outer layer of the glands, secretes corticosteroids, including cortisol (a stress hormone), aldosterone (which regulates blood pressure), and sex hormones (such as testosterone and oestrogen). Meanwhile, the inner adrenal medulla produces adrenaline (epinephrine) and noradrenaline (norepinephrine), which play key roles in the body's fight-or-flight response.

Common disorders and their symptoms:

Adrenal gland disorders encompass a spectrum of conditions, each with its own set of symptoms and underlying causes. One prevalent disorder is adrenal insufficiency, characterised by inadequate production of cortisol and sometimes aldosterone. Symptoms can include fatigue, weight loss, low blood pressure, nausea, and darkening of the skin, among others.

Cushing's syndrome, on the other hand, results from excessive cortisol production, whether from adrenal tumours, pituitary tumours, or prolonged use of corticosteroid medications. Its symptoms often include weight gain, particularly in the face and abdomen (creating a "moon face" and "buffalo hump"), thinning of the skin, easy bruising, and muscle weakness.

Another notable disorder is Addison's disease, a rare but serious condition marked by adrenal insufficiency due to autoimmune destruction of the adrenal glands. Symptoms may include extreme fatigue, weight loss, abdominal pain, salt cravings, and potentially life-threatening complications like adrenal crisis.

Diagnostic challenges:

Diagnosing adrenal gland disorders can be a formidable task, given the overlap in symptoms and the glands' intricate hormone production pathways. Healthcare providers often rely on a combination of medical history, physical examination, blood tests measuring hormone levels, imaging studies (such as CT or MRI scans), and specialised stimulation tests to assess adrenal function accurately.

Treatment approaches:

Management of adrenal gland disorders aims to restore hormonal balance, alleviate symptoms, and address underlying causes. For adrenal insufficiency, hormone replacement therapy with oral corticosteroids like hydrocortisone is typically prescribed. Patients may also require mineralocorticoid replacement if aldosterone production is deficient.

In cases of Cushing's syndrome, treatment varies depending on the cause. Surgical removal of tumours, radiation therapy, or medications to block cortisol production may be recommended. Additionally, gradual tapering of corticosteroid medications in those with iatrogenic Cushing's syndrome is crucial under medical supervision.

For Addison's disease, lifelong hormone replacement therapy with corticosteroids and, if necessary, mineralocorticoids are essential. Patients must also learn to adjust their medication doses during times of stress or illness to prevent adrenal crisis.

Dr Kaustubh Nisal is an esteemed endocrinologist. You can schedule an appointment with Dr Nisal on his Top Doctors profile.