Adrenal Disorders

Overview

What are adrenal disorders?

There are many conditions that can lead to problems with the adrenal gland function. The adrenal glands are small and shaped liked triangles and are located just above each kidney. They are sometimes called suprarenal glands. Their job is to make hormones that you need to keep your metabolism, blood pressure, immune system and stress response in balance.

Adrenal disorders are the result of your glands making too much or not enough of certain hormones. Hormones produced by the adrenals include hydrocortisone (also called cortisol), adrenaline and aldosterone.

You can think of dominoes and how one movement by one domino sets off a chain reaction, making the next domino in line fall down. If something happens and the next domino doesn’t get the message, the effect is ruined.

What are common types of adrenal disorders?

There are different conditions related to your adrenal glands. Some of the most common include:

  • Addison’s disease, also called adrenal insufficiency. In this disorder, you don’t produce enough cortisol and/or aldosterone.
  • Cushing’s syndrome. In this disorder, your levels of cortisol are too high. This term can be applied when large doses of steroids are given to treat certain medical conditions.
  • Congenital adrenal hyperplasia. This term refers to genetic condition in which your adrenal glands are not able to make cortisol well. As a result ACTH is elevated. Depending on the defect higher levels of male hormone might be made.
  • Adrenal gland suppression. This is a type of adrenal insufficiency that is related to outside sources of cortisol or related synthetic hormones such as prednisone or dexamethasone.
  • Hyperaldosteronism. If you have this condition, your body produces too much aldosterone which can lead to blood pressure elevation and potassium loss.
  • Virilization. This condition happens when your body produces too much of the male sex hormones and is only apparent in females or boys before puberty.

There are also conditions of the adrenal glands related to growths (tumors). These include:

  • Adrenal gland tumors. Tumors can disrupt hormone output, but are usually noncancerous.
  • Adrenocortical carcinoma. This rare condition refers to cancer forming in the adrenal gland’s outer layer.
  • Pheochromocytoma. If you have this condition, your glands make too much epinephrine and norepinephrine which can raise blood pressure or make your heart race.
  • Pituitary tumors. Abnormal growth on the pituitary gland can cause adrenal gland conditions by disrupting the amount of hormones made by the adrenal glands. ACTH producing tumors cause Cushing’s disease. If tumors are large enough, they may press on the normal pituitary cells and cause deficiency of ACTH and secondary adrenal insufficiency.

How common are adrenal disorders?

Adrenal disorders can happen to anyone. Within the individual conditions, some of them may happen more often to females than males, such as Cushing’s syndrome.

What is adrenal insufficiency?

Adrenal insufficiency happens when the adrenal glands don’t produce enough cortisol and sometimes aldosterone. The production decreases when the adrenal cortex (the glands’ outer layer) is destroyed. This occurs most often when you have an autoimmune disease that causes your body to attack the glands. It can also be caused by tumors, tuberculosis and other types of infections. This condition is known as primary adrenal insufficiency.

Secondary adrenal insufficiency, which is more common than the primary form, happens because you don’t have enough of adrenocorticotropin (ACTH), the hormone secreted by the pituitary gland. If your pituitary doesn’t make enough ACTH, your adrenal glands don’t make enough cortisol.

Secondary adrenal insufficiency most often happens when you have been taking glucocorticoids (like prednisone) for an extended amount of time and then stop too quickly rather than tapering down gradually. It can also develop due to tumors in the pituitary glands pressing on the normal pituitary cells or from surgery or radiation to the pituitary gland.

What does adrenal crisis mean?

Adrenal crisis is a medical emergency. It’s the most serious complication of adrenal insufficiency and happens due to a severe lack of cortisol. An adrenal crisis can be life-threatening. Symptoms of adrenal crisis include:

  • Severe pain in your lower body that comes on quickly.
  • Bouts of vomiting and diarrhea.
  • Weakness.
  • Confusion and loss of consciousness.
  • Low blood glucose,
  • Low blood pressure.

If you have adrenal insufficiency, you should always have an injectable form of glucocorticoid medicine with you and you should wear some type of medical alert jewelry with that information. Make sure your family and friends know how to give the injection in the case of an emergency.

Other hormone imbalances and symptoms can occur with adrenal disorders. These include having too much potassium (hyperkalemia) or not enough sodium (hyponatremia) in your blood.

Symptoms and Causes

What are the risk factors for adrenal disorders?

In many cases, the causes for adrenal disorders aren’t known. However, some types of adrenal disorders are linked to genetics. Others may result more frequency if you have to take or choose to take certain types of drugs, such as steroids. Steroids are used to treat many types of diseases, but you should always be aware of their many side effects.

What causes adrenal disorders?

Adrenal gland disorders are caused by problems with the glands themselves that cause overproduction or underproduction of hormones. They are also caused by problems in other glands, such as the pituitary gland. Genetics can also play a part in certain adrenal disorders. In many cases, no one really knows why the disorders develop.

What are the symptoms of adrenal disorders?

The symptoms of adrenal disorders vary depending on which hormones are involved. Many of the symptoms of adrenal disorders are similar to those of other illnesses.

Symptoms of high levels of cortisone (Cushing’s disease) include:

  • Upper body obesity, while arms and legs stay thinner. (A common trait called a Buffalo hump refers to a lump in between the shoulders.)
  • Being tired and confused.
  • Developing high blood pressure and diabetes.
  • Skin that bruises easily.
  • Wide purplish streak marks on the abdominal skin.

Symptoms of high levels of aldosterone include:

  • High blood pressure.
  • Low potassium levels.
  • Weakness.
  • Pain and spasms in your muscles.

Symptoms of high levels of male sex hormones are only apparent in females or in young boys before puberty. These include:

  • Growing facial hair and or balding.
  • Developing acne.
  • Having a deeper voice.
  • Becoming more muscular.
  • Developing a greater sex drive.

Developing masculine traits is called virilization.

Diagnosis and Tests

How are adrenal disorders diagnosed?

Your healthcare provider will likely start by asking questions about your symptoms. They will then order tests to determine the levels of hormones in your saliva, blood and urine.

If your provider suspects tumors, they might order imaging tests such as CT scans, MRIs or nuclear imaging tests.

Your regular healthcare provider may refer you to an endocrinologist, a specialist in hormones and diseases of the endocrine system.

Management and Treatment

How are adrenal disorders treated?

Treatment of adrenal disorders depend on the disorder itself. Some conditions will require medications to add to hormone levels. Your provider may suggest surgery or radiation for disorders that involve tumors.

What are the complications of adrenal disorders?

The adrenal glands and the hormones they control are important to many of your body’s functions. Untreated disorders can have serious complications. Some of them may be life-threatening.

Prevention

How can I prevent adrenal disorders?

Since researchers don’t know why certain adrenal disorders happen, there seems to be no way to prevent them from happening.

In the cases where you might be tempted to take male hormones to build muscle mass, you should stop and consider that you may end up damaging other glands.

Living With

When should I contact my healthcare provider about adrenal disorders?

You should always contact your healthcare provider when you have symptoms that concern you, with or without a diagnosis of an adrenal disorder. Some of these might include:

  • Losing weight without trying, or gaining weight primarily in the upper body.
  • Feeling so tired that you can’t get through your daily tasks.
  • Being in any type of pain that is severe or that doesn’t stop.
  • Experiencing changes in hair growth.
  • Experiencing skin changes, like bruising easily or developing stretch marks.

If you have adrenal insufficiency, ask your doctor for an injectable glucocorticoid that you can carry with you. Make sure that you know how to inject yourself, and that your family and friends also know how and when to inject you.

A note from Cleveland Clinic

The adrenal glands play an important part in keeping your body healthy. Disorders of these glands can affect many body functions. Your healthcare provider may suggest you see an endocrinologist regularly to monitor your condition. Your treatment plan might change when your situation changes, such as when you are in a high-stress time during an illness or surgery. Most of the adrenal disorders are manageable when you become an active part of your healthcare team.

Last reviewed by a Cleveland Clinic medical professional on 06/07/2021.

References

  • National Institute of Diabetes and Digestive and Kidney Diseases. Adrenal Insufficiency and Addison’s Disease. (https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease) Accessed 6/9/2021.
  • National Library of Medicine. Adrenal Gland Disorders. (https://medlineplus.gov/adrenalglanddisorders.html) Accessed 6/9/2021.
  • National Institute of Child Health and Human Development. About Adrenal Gland Disorders. (https://www.nichd.nih.gov/health/topics/adrenalgland/conditioninfo) Accessed 6/9/2021.
  • American Association of Clinical Endocrinology. All About the Adrenal Glands. (https://www.aace.com/disease-and-conditions/adrenal/all-about-adrenal-glands) Accessed 6/9/2021.
  • Merck Manual Consumer Version. Overview of the Adrenal Glands. (https://www.merckmanuals.com/home/quick-facts-hormonal-and-metabolic-disorders/adrenal-gland-disorders/overview-of-the-adrenal-glands#v39676762) Accessed 6/9/2021.

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