Adrenal Disorders
What Are Adrenal Disorders?
Adrenal disorders refer to a group of conditions that affect the adrenal glands, which are small, triangular-shaped glands located on top of the kidneys. These glands are responsible for producing hormones that regulate various bodily functions, such as metabolism, blood pressure, and response to stress. Tumors or growths can occur in the adrenal glands. Adrenal disorders can be divided into disorders from the cortex versus disorders from the medulla. Cortical adrenal disorders include Cushing’s syndrome and Cushing’s disease, congenital adrenal hyperplasia, Addison’s disease, among others. Medullary adrenal disorders include pheochromocytoma as well as others.
Adrenal insufficiency is when there is an insufficient production of hormones like cortisol, also known as corticosteroids or glucocorticoids, in the body leading to severe illness. The most common cause of adrenal insufficiency is abruptly withdrawing prescribed corticosteroids. If there is too much cortisol/steroids in the body, the brain will reduce production of ACTH as a response. When one is on an oral glucocorticoid for an extended period ACTH depletes almost entirely. ACTH is necessary for natural adrenal cortisol production. If the corticosteroid is abruptly stopped, there is a lag time for ACTH to come back up to normal, thus the body becomes deficient in overall steroid production. On occasion, this process can be permanent.
What Are The Causes of Adrenal Disorders?
Adrenal disorders can be caused by a variety of factors, including genetic mutations, autoimmune diseases, infections, and tumors. In some cases, adrenal disorders may be caused by medications, such as corticosteroids, which are commonly used to treat inflammatory conditions. Addison’s disease, for example, is an autoimmune disorder that occurs when the immune system attacks the adrenal glands, causing them to produce insufficient amounts of hormones. On the other hand, Cushing’s syndrome is often caused by a tumor that develops in the pituitary gland, leading to excessive production of cortisol, a hormone produced by the adrenal glands. Proper diagnosis and treatment of adrenal disorders require a thorough evaluation by a healthcare professional, who can determine the underlying cause of the condition and recommend an appropriate treatment plan.
The most common cause of adrenal insufficiency is abruptly withdrawing prescribed corticosteroids. When there is too much cortisol/steroids in the body, the brain will reduce production of ACTH as a response. When one is on an oral glucocorticoid steroid for an extended period ACTH depletes almost entirely. ACTH is necessary for natural adrenal cortisol production. If the corticosteroid is abruptly stopped, there is a lag time for ACTH to come back up to normal, thus the body becomes deficient in overall steroid production.
What Are The Signs And Symptoms of Adrenal Disorders?
Adrenal disorders can cause a wide range of signs and symptoms, which can vary depending on the specific condition and the severity of the disorder. Some common signs and symptoms of adrenal disorders include fatigue, weakness, weight gain or loss, high blood pressure, changes in blood sugar levels, and mood changes. Individuals with adrenal disorders may also experience skin changes, such as darkening or thickening of the skin, or develop abdominal pain or other gastrointestinal symptoms. In some cases, adrenal disorders may also affect reproductive and sexual function, causing irregular menstrual cycles or reduced libido.
How Are Adrenal Disorders Diagnosed?
The diagnoses of both Adrenal Insufficiency and Cushing’s Syndrome are made initially through a history and physical examination and a one-time cortisol level, often in the morning when cortisol levels should be the highest. If the cortisol level is markedly reduced or inappropriately normal then the patient may have adrenal insufficiency. A Cosyntropin stimulation test can be administered to help make a definitive diagnosis. On the other hand, if cortisol is markedly elevated or there is a relatively high index of suspicion for cortisol excess, there are a number of tests that could be done including but not limited to a 24-hour urine cortisol, late-night salivary cortisol, or the overnight 1 mg dexamethasone suppression test.
What Are Possible Treatments For Adrenal Disorders?
The treatment of adrenal disorders depends on the underlying cause of the condition and the severity of the symptoms. In some cases, medications may be prescribed to replace or regulate hormone production from the adrenal glands.
The treatment of choice for Cushing’s disease (ACTH-producing pituitary tumor) is transsphenoidal brain surgery when a clearly circumscribed pituitary tumor can be identified at surgery. This has a relatively high cure rate for the elevated cortisol issue, but can put a patient at risk for developing an underactive pituitary leading to hypothyroidism, infertility, diabetes insipidus, or low blood sodium. This is because the pituitary not only controls ACTH production, but other hormones as well. The treatment of choice for Adrenal Insufficiency is long term glucocorticoid steroid therapy. One of the biggest risks of long term glucocorticoid use is Cushing’s syndrome, therefore close monitoring is a requirement for both of these conditions with an endocrinologist.
Are There Preventative Steps or Measures To Avoid Adrenal Disorders?
Maintaining a healthy lifestyle that includes regular exercise, a balanced diet, and stress management techniques may help reduce the risk of developing certain adrenal disorders. It is also important to avoid or limit exposure to environmental toxins, such as pesticides or chemicals, that may affect adrenal gland function.
What Are The Risks Of Adrenal Disorders If Left Untreated?
If left untreated, adrenal disorders can lead to a range of complications and potentially serious health problems. For example, untreated Addison’s disease can cause low blood pressure, dehydration, and a life-threatening condition known as an Addisonian crisis, which can cause symptoms such as severe pain, vomiting, and loss of consciousness. Similarly, Cushing’s syndrome can lead to a range of complications, including high blood pressure, diabetes, osteoporosis, and increased risk of infections. Adrenal tumors may also be malignant and can spread to other parts of the body if left untreated.
