Adrenal gland disorders

What are the adrenal glands?

The adrenal glands are located above the kidneys. Weighing around 15 grams each, people have two adrenal glands. The adrenal glands produce four main kinds of hormones, including:

• Glucocorticoid: the main hormone is called cortisol, which is responsible for regulating the body’s response to anxiety. One of the most important functions of cortisol is to increase blood glucose levels.
• Mineralocorticoid: the main hormone is called aldosterone, which regulates sodium levels in the blood and prevents the kidneys releasing excessive salt.
• Androgen: the main hormone is called DHEA (dehydroepiandrosterone). Levels of DHEA are small until puberty, after which they increase until the age of around 30 and then slowly decrease.
• Catecholamine: the main hormones are adrenaline and noradrenaline. These hormone are responsible for the body’s reaction to ‘flight or fright’ situations, to stop the body systems from collapsing and control blood pressure on daily.

Cortisol, DHEA and aldosterone are created in the outer section of the adrenal glands, while noradrenaline and adrenaline are created in the medulla (the core) of the adrenal glands.

These hormones have a range of essential roles in the body:

• Controlling metabolic processes.
• Controlling water and sodium levels in the blood.
• Regulating blood sugar levels.
• Regulating the body’s response to stressful situations.
• Facilitating a healthy pregnancy.
• Regulating the levels of potassium in the blood.
• Regulating kidney function.
• Facilitating puberty.

Adrenal gland disorders

Adrenal gland disorders affect the function of the adrenal glands, which can cause symptoms and problems to other systems in the body. Examples of adrenal gland disorders include:

Cushing’s syndrome: this is a rare illness and occurs as a result of the overproduction of cortisol, a type of glucocorticoid hormone. Symptoms of Cushing’s syndrome include:

• High blood pressure.
• Bruising easily.
• Thinning of the skin.
• Weight gain (especially in the upper body).
• Lack of libido.
• The face becoming rounded.

Cushing’s syndrome usually develops as a side-effect of corticosteroid treatment. Corticosteroids are used to reduce inflammation and stem the action of the immune system in people who have autoimmune conditions. Cushing’s syndrome can also be caused by a tumour developing in a different gland in the body (this is known as endogenous Cushing’s syndrome), though this is very rare. Women are fives time more likely to develop endogenous Cushing’s syndrome than men. The main way to treat Cushing’s syndrome is to reduce the dose of corticosteroids, which must be done gradually. If Cushing’s syndrome is brought on by a tumour treatment will usually involve removing the tumour via surgery.

Congenital adrenal hyperplasia: this is a rare genetic condition which causes a lack of cortisol to be produced by the adrenal glands. People who have congenital adrenal hyperplasia often suffer from other hormone imbalances, as not enough aldosterone is produced in contrast to overproduction of androgen.

Addison’s disease: this occurs when the adrenal glands do not produce enough hormones. Most cases of Addison’s disease are caused by problems affecting the immune system. Symptoms of Addison’s disease include:

• Loss of weight.
• Muscle weakness.
• Low blood pressure.
• Tiredness and fatigue (this usually gets worse over the course of time).

Addison’s disease requires lifetime hormone treatment and or it can be lethal.

Pituitary tumours: this gland is located at the base of the brain behind the bridge of the nose. It is of great importance, overseeing a number of roles in the body as well as other glands, such as the adrenal glands. Pituitary tumours, which are usually benign, can develop on the pituitary gland, causing functions to be disrupted as a result of hormonal imbalances. In rare cases pituitary tumours can cause Cushing’s syndrome, which is also known as Cushing’s disease.

Treating adrenal disorders

Treatment varies according to the specific disorder:

Cushing’s syndrome: in most cases Cushing’s syndrome can be treated effectively by reducing the dose of corticosteroids. However, this must be done gradually because stopping the course all of a sudden can be dangerous. In cases where the condition is caused by a tumour (known as endogenous Cushing’s syndrome) surgery is usually carried out to remove the tumour.

Congenital adrenal hyperplasia: there is no cure for this condition, but it can be controlled effectively by taking hormone replacement medication.

Addison’s disease: Addison’s disease can be fatal, so it is important that it is treated and managed effectively. People with Addison’s treatment will need to take hormone replacements for the rest of their lives and it is also important that they carry a badge stating that they have the disease, advising what medication and dosage is required in the event of them becoming ill.

Pituitary tumours: surgery is often used to remove pituitary tumours, although this is not always possible. If the tumour is large or the individual does not want surgery, medication can be used and radiotherapy is also an option. Doctors will select the most suitable treatment method based on the size and type of tumour. Details of the procedure, including the potential risks, will be explained to patients before they decide to go ahead and have surgery.