Adrenal Gland Disorders

About

The adrenal glands are endocrine glands located on the top of each kidney; they are responsible for releasing different hormones that serve vital functions in the body such as:

• Maintenance of body metabolism
• Regulation the salt and water balance
• Bringing about “the fight or flight” response to stress
• Maintenance of pregnancy
• Control of sexual maturation

Hormones secreted by adrenal glands include- cortisol, aldosterone, adrenaline and noradrenaline. The adrenals are also an important source of the sex hormones oestrogen and testosterone.

What are Adrenal Gland Disorders?

Significant disorders arise when the adrenal glands do not work properly. Adrenals may produce too much hormones or too little hormones, each having a multitude of implications.

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Disorders may be due to genetic mutation, tumours or infections. The secretion of hormones from the adrenals is controlled by a gland in the brain called the pituitary. Therefore, pituitary dysfunction can also cause adrenal gland disorders. Some medications also lead to malfunction of the adrenals.

Conditions Associated with Adrenal Gland Disorders

The conditions that can arise due to adrenal gland disorders are:

• Cushing’s Syndrome - This condition arises due to excess levels of cortisol hormone in the body. Apart from adrenal gland tumours, pituitary and some other tumours, and prolonged or excess use of steroid medications can also produce Cushing’s syndrome.

• Congenital Adrenal Hyperplasia (CAH) - CAH is a genetic disorder that creates imbalances in the levels of cortisol, androgen and aldosterone. Aldosterone is concerned with the control of blood pressure, the levels of salt and potassium.
• Pheochromocytoma- This is a tumor that develops in the adrenal medulla (the inner part of the gland). It leads to an excess production of adrenaline in the body.
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• Adrenal gland suppression- The normal adrenal activity may be suppressed by unscientific usage of steroid medications such as prednisolone, hydrocortisone, or dexamethasone.
• Addison’s disease - This is an auto immune disease in which the body attacks its own adrenal glands. The adrenal glands fail to produce enough cortisol; there can also be a deficiency of aldosterone.
• Hyperaldosteronism- Here the adrenals produce an excess of aldosterone; it is due to an abnormal growth of the glands.

Symptoms of Adrenal Gland Disorders

Adrenal gland disorders produce a broad range of symptoms depending on the type of disorder.

Cushing’s syndrome-

• Abnormal distribution of body fat. Upper body obesity, round face and neck, and thinning of arms and legs.
• Changes in the skin- acne; blue striae on the abdomen or under arm area
• High blood pressure

• High blood sugar levels
• Behavioural changes such as irritability, depression
• Slow growth rates in children
• Abnormal hair growth and menstrual irregularities in women; decreased fertility and reduced or absent sex drive in men.

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Hyperaldosteronism-

• Moderate to high blood pressure
• Low levels of potassium
• Muscle cramps or spasms
• Excessive urination
• Headache
• Fatigue, generalised weakness

Congenital Adrenal Hyperplasia (CAH)

Mild form of CAH-

• Failure to gain an average height
• Precocious puberty
• Acne
• Menstrual irregularities; difficulty getting pregnant
• Excess facial hair in women

Severe-

• Dehydration
• Low Blood Pressure
• Low levels of blood sugar
• Changes in the external genitalia
• Failure to gain an average height
• Precocious puberty
• Acne
• Menstrual irregularities; difficulty getting pregnant
• Benign testicular tumours and infertility in men

Pheochromocytoma

• Episodes of palpitations (due to a rapid heart rate), headache, sweating

• Episodes of high or low blood pressure
• Anxiety or panic attack
• Tremors of the hands
• Pale skin
• Blurring of vision
• Weight loss
• Abdominal pain and constipation
• High blood sugar level
• Psychiatric issues

Addison’s disease

• Weight loss
• Weakness and extreme fatigue
• Nausea and/or vomiting
• Low blood pressure with a feeling of dizziness upon standing
• Dark patches on the skin

• Craving for salt
• Psychiatric changes such as depression

Diagnosis Adrenal Gland Disorders

Various modalities of examination are performed by your doctor. Tests used include:

Cushing’s disease- Cortisol levels in saliva, cortisol levels in the urine over 24 hours, cortisol suppression test (it is tested whether a synthetic steroid, called dexamethasone, which suppresses cortisol production by the body).

Addison’s disease- Blood test to measure cortisol and adrenocorticotropic hormone (ACTH) levels, ACTH stimulation test (an hour-long test during that uses a synthetic form of ACTH)

CAH- CAH can be identified by a newborn-screening blood test. Examination of the external genitalia can also give clinical evidences.

Pituitary tumours- These require a complete neurological examination that includes physical examination, imaging and blood investigations.

Pheochromocytoma- Tests measure the levels of catecholamines in blood or urine.

Hyperaldosteronism- Tests to measure aldosterone and potassium levels, and CT scan.

Treatment of Adrenal Gland Diseases

The treatment depends upon the type of disorder. Medical management involves drugs that manipulate the production of hormones in the body; hormone replacement is used in some cases (e.g. Addison’s disease). It is also important to treat an underlying modifiable cause.

Surgery may be required to remove tumours in the adrenal gland (in certain cases surgery to remove the one or both of the adrenal glands is done). Pituitary gland can be removed by a minimally invasive surgery.