Adrenal gland disorders: what patients need to know

The adrenal glands are a pair of small glands that sit just above each kidney. Despite their size, they play a vital role in regulating many of our body’s essential functions, including metabolism, immune response, blood pressure, and stress response. They produce hormones such as cortisol, adrenaline, and aldosterone, each of which has a distinct function in keeping the body balanced. Adrenal gland disorders occur when these glands produce either too much or too little of these critical hormones, leading to various symptoms and health issues.

We speak to an experienced consultant endocrinologist, who explains all you need to know.

What causes adrenal gland disorders?

Several conditions can lead to adrenal gland dysfunction. One common disorder is Addison’s disease, where the adrenal glands do not produce enough cortisol and aldosterone, leading to symptoms like fatigue, muscle weakness, and weight loss. This condition is often due to an autoimmune response, where the body mistakenly attacks the adrenal glands. Another disorder is Cushing’s syndrome, which results from an excess of cortisol. This may occur if the body produces too much cortisol on its own, often due to a tumour, or from prolonged use of corticosteroid medications.

In some cases, adrenal disorders arise due to a genetic condition known as congenital adrenal hyperplasia (CAH). In CAH, the adrenal glands lack the enzymes required to produce certain hormones, leading to an imbalance that may affect growth, puberty, and other bodily functions. Additionally, adrenal tumours—whether benign or cancerous—can also disrupt hormone production, potentially causing serious health issues.

What symptoms should I look for?

The symptoms of adrenal gland disorders vary depending on which hormones are affected. In Addison’s disease, symptoms often include fatigue, muscle weakness, low blood pressure, and salt cravings, which may develop slowly over time. On the other hand, Cushing’s syndrome typically presents with symptoms such as weight gain, particularly around the abdomen and face, high blood pressure, easy bruising, and mood swings.

With conditions like CAH, symptoms may appear in infancy or childhood and can include abnormal growth patterns and early or delayed puberty. In adults, CAH can cause menstrual irregularities in women and infertility in both men and women. Tumours of the adrenal glands can lead to either an overproduction or underproduction of hormones, depending on the type, which may result in symptoms like high blood pressure, heart palpitations, or, in some cases, very few noticeable symptoms until the tumour grows larger.

How are adrenal gland disorders diagnosed?

Diagnosis usually begins with a series of blood and urine tests to measure hormone levels. For example, cortisol levels may be tested at different times of the day to detect irregularities. If a disorder is suspected, imaging studies such as CT (computed tomography) scans or MRIs (magnetic resonance imaging) might be recommended to view the adrenal glands directly. Additionally, a test called an ACTH (adrenocorticotropic hormone) stimulation test can help assess how well the adrenal glands are functioning in response to hormonal prompts from the brain.

What treatment options are available?

The choice of treatment for adrenal gland disorders will depend on the specific condition. For Addison’s disease, hormone replacement therapy is usually necessary to replace deficient cortisol and aldosterone. In the case of Cushing’s syndrome, treatment may involve surgery to remove a tumour, medication to reduce cortisol levels, or adjusting steroid use if medication is the cause. CAH often requires hormone replacement and careful monitoring, especially during periods of stress or illness. If an adrenal tumour is present, surgery may be needed, particularly if the tumour is affecting hormone levels or showing signs of growth.

In all cases, managing adrenal gland disorders requires regular monitoring by a healthcare provider to adjust treatments as necessary and to ensure overall well-being.