Adrenal Gland Disorders

Adrenal Gland Disorders

Adrenal gland disorders at a glance

  • Adrenal gland disorders are conditions interfering with the two adrenal glands that produce several important hormones, thus affecting body functions such as blood pressure, development and weight.
  • Adrenal gland disorders can disrupt how people’s bodies mature sexually and how women maintain pregnancy.
  • Some adrenal gland disorders are congenital (born with it), others occur because of immune conditions, infection, tumors or stress.
  • Doctors can treat some adrenal gland disorders with medication. Other adrenal gland disorders need to be treated with surgery.

What are adrenal gland disorders?

The adrenal glands are endocrine (hormone) glands that are located near the top of each kidney, and disorders of these adrenal glands can disrupt several important functions of the body. The glands produce hormones that control the body’s “fight or flight” instinct, which is the physiological reaction to a perceived attack or a health threat. These hormones also regulate the way the body functions.

Adrenal­­–related functions that can be affected by adrenal gland disorders include blood pressure, heart rate, sweating and the production of the sex hormones testosterone and estrogen. They also help regulate how the body uses salt and potassium, and how people’s bodies mature sexually and maintain pregnancy.

Types of adrenal gland disorders

People may experience any of several types of disorders of the adrenal gland, including:

  • Addison’s disease (also called adrenal insufficiency) – a potentially life-threatening disease that occurs in about 4 in every 100,000 people. With Addison’s disease, the body’s adrenal glands are underactive. This means they do not produce enough of the hormones cortisol and/or aldosterone.
  • Adrenal cancer – a rare, aggressive type of cancer in the outside layer of the adrenal gland.
  • Adrenal incidentaloma – tumors or masses (1cm or larger in size) found on the adrenal gland during an examination for some other condition.
  • Congenital adrenal hyperplasia (CAH) – a genetic disorder that prevents the body from making enough cortisol. CAH also can cause other hormone problems. The mild form is quite common. As many as 1 in 100 people have mild CAH.
  • Conn’s syndrome (primary hyperaldosteronism) – overproduction by the adrenal glands of hormones called mineralocorticoids (aldosterone).
  • Cushing’s disease – when the adrenal glands make too much cortisol. In some cases Cushing’s disease is caused by a tumor in the pituitary gland, which is located at the base of the brain. The pituitary gland produces hormones that affect how the body works in many ways. Pituitary tumors are nearly always benign.

Causes of adrenal gland disorders

Adrenal gland disorders can be caused by medication or the body itself. The most common causes of these disorders are:

  • Genetic conditions a person is born with
  • Tumors, including pheochromocytomas (a rare tumor that can cause the adrenal gland to make too many hormones)
  • Infections
  • Autoimmune response
  • Problems with other endocrine (hormone) glands. The most common problem is with the pituitary gland, which helps regulate the adrenal gland.
  • Certain medications. Taking high-dose steroids can cause Cushing’s disease. Suddenly stopping taking glucocorticoids (such as prednisone) can cause adrenal insufficiency. In turn, this can cause Addison’s disease.

Symptoms of adrenal gland disorders

The symptoms of adrenal gland disorders vary depending on what is causing the disorder. All adrenal gland disorders may cause abdominal pain, weakness, weight loss or gain, and fatigue.

Specific symptoms of certain disorders may also include the following.

  • Adrenal cancer or other adrenal tumors may cause abdominal pain and weight loss. Patients might have high blood sugar and/or high blood pressure because of overproduction of hormones. Women may experience irregular periods or increased hair on their bodies.
  • Addison’s disease may cause lack of appetite, nausea, vomiting, constipation and diarrhea. Addison’s also can cause darkened skin, dizziness when standing, and muscle and joint pain. If a person doesn’t receive treatment for Addison’s disease, he or she might have an adrenal crisis, which can be fatal.
  • Congenital adrenal hyperplasia (CAH) can be diagnosed in children who have symptoms such as shorter than average height and early puberty. A more severe form may include low blood pressure or low blood sugar, trouble retaining salt in the body, and issues with the reproductive system. These may include altered genital appearance and difficulty getting pregnant (in women) and benign testicular tumors and infertility (in men).
  • Cushing’s disease can include symptoms such as:
  • Weight gain in the torso and a round face
  • Fragile skin, with thinning
  • Poor wound healing and easy bruising
  • Increased thirst and urination
  • High blood pressure and/or high blood sugar
  • Irritability, mood swings, depression and/or anxiety
  • And in women, lack of menstrual periods or the appearance of facial hair
  • Pheochromocytoma may cause episodes of high blood pressure, sweating, headache and heart palpitations brought on by stress, exercise or indigestion caused by eating certain foods, such as some types of cheese that contain tyramine.

Diagnosis & treatment of adrenal gland disorders

To diagnose a disorder of the adrenal glands, physicians may order various tests, such as:

  • Blood tests to measure how well the body produces the hormone cortisol
  • Tests to measure insulin tolerance
  • 24-hour urine collection
  • Imaging, such as a computed tomography (CT) scan of the adrenal glands and/or a magnetic resonance imaging (MRI) scan of the pituitary gland
  • For pheochromocytoma, a specialized scan called a meta-iodobenzylguanidine (MIBG) scan.

The physician also will review a person’s medical history and study all the medications he or she takes.

Treatment of adrenal gland disorders falls into two general categories. Some conditions are treated with medication, others need surgical treatment.

  • Addison’s disease (adrenal insufficiency) is treated with hormone replacement. Steroids such as hydrocortisone or prednisone can replace the cortisol that the body does not produce in adequate amounts. Patients also may take fludrocortisone to replace aldosterone. Patients should wear a medical alert to ensure that medical providers are aware of their condition.
  • Adrenal cancer is treated with surgery to remove the cancer. This aggressive cancer must be treated quickly to try to avoid allowing the cancer to metastasize (spread to other parts of the body).
  • Pheochromocytoma is treated most commonly with surgery. Doctors also might treat pheochromocytoma with chemotherapy or radiation therapy.
  • Adrenal incidentalomas are treated depending on how problematic the doctor determines them to be.
    • If they are small and do not appear to be very active, the physician may recommend watching and waiting.
    • For larger, more aggressive incidentalomas, the physician may recommend surgical removal.