Adrenal Gland Disorders

Your adrenal glands are located above each of your kidneys and consist of two parts, each producing hormones for different purposes. The hormones, such as adrenaline and noradrenaline, produced by the medulla regulate the body’s reaction to stress. The other region of the adrenal glands is called the cortex which affects blood pressure and blood sugar levels, growth, and sexual characteristics, hormones, such as cortisol, aldosterone, and testosterone.

• What are adrenal disorders?
• What is adrenal fatigue?
• Symptoms of adrenal gland disorders
• Diagnosing adrenal gland disorders
• Treating adrenal gland disorders
• Types of adrenal disorders
• When to see an Endocrinologist

What are Adrenal Disorders?

When the adrenal glands produce too much or not enough hormone, this may be due to an adrenal disorder in which the glands are overactive or underactive.

Underactive adrenal gland disorders stem from either a problem with the adrenal gland or an inadequate secretion of adrenocorticotropic hormone by the pituitary gland. Disorders that result in underactive adrenal glands include congenital adrenal hyperplasia, primary adrenal insufficiency (Addison’s disease), secondary adrenal insufficiency, and polyglandular autoimmune syndrome Type 1 and Type 2.

Overactive adrenal gland disorders are often the result of a tumor of the adrenal gland. Pheochromocytomas are rare, typically benign tumors that lead to the production of excessive amounts of adrenaline or noradrenaline. Primary hyperaldosteronism, or Conn’s syndrome, is also caused by a tumor and occurs when too much aldosterone is made, sometimes leading to high blood pressure. Cushing’s syndrome is a condition in which excess release of cortisol from the adrenal glands occurs due to a pituitary disorder.

What is adrenal fatigue?

Adrenal fatigue occurs when your adrenal glands produce too many or not enough hormones. Hyper and hypo functioning of the gland can lead to adrenal fatigue. Signs and symptoms adrenal insufficiency also include body aches, skin discoloration, unexplained weight loss, loss of body hair, low blood pressure, and lightheadedness.

Symptoms of Adrenal Gland Disorder

Signs that your adrenal glands are underactive include poor appetite, fatigue, weakness, fatigue, and gastrointestinal problems.

Signs that your adrenal glands may be overproducing include headaches, sweating, chest pain, high blood pressure, and anxiety.

Diagnosing Adrenal Gland Disorders

We use a variety of tests and procedures to diagnose adrenal gland disorders. To determine the level of activity of the adrenal glands, we conduct a minimally invasive procedure called adrenal vein sampling (AVS), by collecting blood samples through a catheter from the adrenal vein and arm.

Our endocrinologists and surgeons diagnose primary and secondary adrenal insufficiency, Addison’s disease, and related conditions, by measuring the adrenal glands’ stress response to adrenocorticotropic hormone (ACTH) which is produced by the pituitary gland and stimulates the adrenal gland to produce cortisol. We inject a small amount of ACTH and then measure the amount of cortisol produced in response.

Treating Adrenal Gland Disorders

If our team has determined that you’ve got an adrenal gland disorder that needs to be treated surgically, options include laparoscopic adrenalectomy, the removal of your adrenal glands, and adrenal sparing surgery, the removal of a tumor in the adrenal gland while leaving the adrenal tissue untouched. We also prescribe spironolactone/eplerenone and steroid hormone replacement when necessary.

Types of Adrenal Disorders

Adrenal disorders are often caused by rare tumors called pheochromocytomas that develop in the adrenal medulla. These tumors cause the adrenal glands to over produce a hormone, catecholamine, that helps with maintaining blood pressure.

Primary hyperaldosteronism (Conn’s Syndrome) is another adrenal disorder that overproduces mineralocorticoids with symptoms ranging from high blood pressure and headaches to excessive urination and thirst to muscle weakness and cramps.

Adrenal Insufficiency (Addison’s disease)

What is Addison’s disease?
Addison’s disease is a potentially life-threatening disease in which the adrenal glands do not produce a sufficient amount of the hormone cortisol and/or aldosterone, and this occurs in about 4 in every 100,000 people. Known as primary adrenal insufficiency, this autoimmune disorder is usually a result of a damaged adrenal cortex which is the outer layer of the adrenal glands. The other more common form of adrenal insufficiency is secondary adrenal insufficiency which happens when there’s a lack of adrenocorticotropin (ACTH), a hormone that the pituitary gland secretes that stimulates the adrenal glands to produce cortisol.

Symptoms of Addison’s Disease
Untreated symptoms can lead to low blood pressure, severe nausea, abdominal pain, and vomiting, so take care to look for the following symptoms that could signal adrenal insufficiency:

• Muscle and joint pain
• Weakness
• Craving salty foods
• Fatigue
• Dizziness or lightheadedness upon standing
• Weight loss
• Darkening of the skin
• Lack of appetite
• Diarrhea
• Nausea
• Constipation
• Vomiting
• Abdominal pain

Addison’s Disease Diagnosis
We use a series of blood tests to measure levels of cortisol in your system and diagnose adrenal insufficiency. If levels are low, we use CT and MRI scans to determine if Addison’s disease is in fact the cause of the cortisol response. Stimulation tests with ACTH tests that we do in our lab and insulin intolerance tests that we do in our endocrinology outpatient department are used to measure cortisol responses.

Addison’s Disease Treatment
To treat adrenal insufficiency, we prescribe a hormone replacement for cortisol with hydrocortisone or prednisone. We may also prescribe fludrocortisone to replace aldosterone if necessary. If you’re unable to take oral medications, we can give you injectable steroids.

Cushing’s Syndrome

Fairly rare, this overproducing hormone disorder is most often found in women between the ages of 20-40.

What is Cushing’s Syndrome?

The opposite result of Addison’s disease, Cushing’s syndrome is when there’s too much cortisol in the body. Cortisol is important because it helps people respond to stress and affects almost all body tissues. Crushing’s syndrome can be caused by a tumor in the adrenal glands or because their body makes too much ACTH.

Symptoms of Cushing’s Syndrome

• Weight gain and fat distribution mostly in the abdominal region
• Lack of menstrual periods; growth of facial hair in women
• Easy bruising
• Increased acne
• Poor wound healing
• Increased thirst and urination
• Thinning of the skin, resulting in purple/pinkish stretch marks on many parts of the body
• Irritability, anxiety, mood swings, and/or depression
• Round face
• Weak muscles
• Weak bones, which can lead to broken bones
• High blood sugar
• Tiredness
• High blood pressure

Cushing’s Syndrome Diagnosis

If your primary doctor refers you to our practice, we will take you through a series of things to determine if Crushing’s syndrome is your diagnosis, including blood tests, a 24-hour urine production, a review of all your medications, and radiographic tests, such as MRIs, CT scans, and other specialized methods that search for tumors on the adrenal or pituitary glands.

Cushing’s Syndrome Treatment
Our treatments vary, depending on the cause of the Crushing’s disease. If it’s a high dose of steroid treatment that caused your symptoms, we may help gradually adjust the dosage. If you have tumors, treatment involves surgery, radiation therapy, and medications that assist in reducing the production of cortisol.

Cushing’s Syndrome vs Cushing’s Disease

Crushing’s syndrome is a disorder resulting from the adrenal glands producing too much cortisol. Crushing’s disease is a disorder that can stem from Crushing’s syndrome when a pituitary gland secretes excessive ACTH.

When to See an Endocrinologist

If you have any of the symptoms listed above, it’s important that you schedule an appointment with us as soon as possible, so we can get you on the road to full health before there are further complications, such as osteoporosis, hypertension, type 2 diabetes, infections, and/or loss of muscle mass and strength.