Definition and Overview

Adrenal problems are medical conditions that affect the adrenal glands. They can be congenital or genetic. They can also occur for other reasons such as hormone imbalance or the presence of tumours.

A body has a pair of adrenal glands. Weighing at least 4 grams each, they are found above the kidneys, which is why they’re sometimes known as suprarenal glands.

These glands are a part of the endocrine system since they secrete hormones. Both major components of the adrenal glands, adrenal medulla (inside) and adrenal cortex (outside), produces different types of hormones, which may be essential or non-essential. These include:

  • Adrenal androgens: These are often called male sex hormones and are present in both men and women, though at different levels. Women need them for reproduction and hair growth.

  • Glucocorticoids: Hormones such as cortisol are related to the body’s flight-fight stress response. When the body senses stress or threat, cortisol is released, causing an increase in heart rate, mental alertness, and elevated blood pressure.

  • Mineralocorticoids: These hormones are responsible for maintaining the correct balance of sodium and water. Too much sodium can cause damage to the kidneys while less water can lead to dehydration.

Imbalances in the production of these hormones can lead to complications such as diabetes and high blood pressure .

Causes of Condition

Some of the most common adrenal problems and their causes are:

  • Cushing syndrome – It is an adrenal disorder caused by an elevated level of cortisol in the bloodstream. It usually happens among people prescribed with glucocorticosteroids, which are necessary to reduce inflammation.

  • Congenital adrenal hyperplasia – This is the general term used to describe congenital and inherited disorders affecting the adrenal glands. People with this condition usually don’t have an enzyme that stimulates proper hormone production.

  • Adrenal cancer – Also referred to as adrenal carcinomas, these are malignant tumours that can develop in the adrenal glands, particularly the adrenal cortex. The actual cause is unknown, although risk factors include genetic syndromes and disorders, as well as environmental risks such as smoking.

  • Addison’s disease – Addison’s disease is a rare adrenal problem that occurs in one in every 100,000 people. It is characterized by the insufficient or repressed production of adrenal hormones, especially cortisol. It is also called chronic adrenal insufficiency. The exact cause is unknown, although it can be an autoimmune disease, in which the body’s immune system attacks the glands, destroying them in the process.

Although the disease can develop gradually, it can also be acute or sudden, and this may result in Addisonian crisis, where the levels of cortisol drop significantly. It is considered as an emergency since the body can go into shock.

Key Symptoms

Cushing syndrome

  • Chronic skin infection
  • Easy bruising
  • Round and red face
  • Weak muscles in the shoulders and hips
  • Central obesity (fat accumulates in the abdomen)
  • Accumulation of fat near the collarbones
  • Hirsutism (excessive hair growth)
  • Irregular menstruation
  • Infertility

Adrenal cancer

  • Physical pain near the tumour site
  • Muscle cramps
  • Low levels of potassium
  • Easy bruising
  • Osteoporosis

Congenital adrenal hyperplasia

  • Chronic electrolyte imbalance
  • Abnormalities in the sexual organ
  • Arrhythmia (abnormal beating of the heart)
  • Hirsutism in women (abnormal hair growth)
  • Menstrual issues
  • Enlargement of the clitoris

The symptoms can be mild or severe. Mild conditions may remain undiagnosed for many years or not at all.

Addison’s disease

  • Difficulty to cope with stress
  • Mood changes including depression
  • Temperature intolerance
  • Low blood pressure
  • Chronic feeling of fatigue
  • Significant hyperpigmentation of the skin

Some health experts also talk about adrenal fatigue, a broad term used for a cluster of symptoms that cannot be identified with a particular illness. It is not a recognized medical illness and therefore doesn’t have any official test. Its proponents believe that it occurs when the adrenal glands are too stressed to produce enough hormones. One of the possible triggers is also chronic stress or a disease such as Addison’s disease or cancer. Some of the most common symptoms of adrenal fatigue may be sudden or unexplained weight loss, low blood pressure, difficulty in sleeping, body aches, fatigue, hyperpigmentation of the skin, and nervousness.

Who to See and Treatments Available

Since most of the problems associated with the adrenal glands are related to hormones, individuals who are experiencing the symptoms described above are encouraged to consult an endocrinologist. For children with adrenal issues, parents can look for endocrinologists that specialize in pediatrics. People with cancer, on the other hand, can approach those with oncology specialty.

Different types of tests may be carried out to diagnose the condition and to rule out other diseases. These include physical and blood tests, especially the one that measures a brain-related hormone called ACTH. Hormone-related tests that measure vital signs such as heart rate or blood pressure, and mineral tests may also be conducted.

In some cases, the patient may undergo an imaging or ultrasound. Both of these tests may be used to obtain a clearer picture of the size and shape of the adrenal glands. Advanced imaging tests like MRI or CT scan can be helpful in diagnosing tumour growths in the glands.

Treatments depend on the condition. If it’s hormone related, the goal is to bring it to balance. Thus, people with Addison’s disease may be prescribed with hormone replacement tablets like hydrocortisone, which should be taken regularly. For those with Cushing syndrome, the doctor may either reduce the dosage or stop the medication altogether. If the medication cannot be stopped, the next option is to control the symptoms.

If the cause of the problem is a tumour, usually the first step is to remove it. A procedure to remove the adrenal gland is called adrenalectomy. This may be necessary if the tumour is malignant. The surgery is useful in preventing the spread of cancer. If there are remaining cancer cells, they can be treated with chemotherapy and radiation therapy.

References:

  • Chaker AJ, Vaidya B. Addison disease in adults: diagnosis and management. Am J Med. 2010;123:409-413.

  • Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 15.

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