Dr Chinnadorai Rajeswaran, consultant endocrinologist explains about adrenal problems and its endocrine management. Please email him, if you need more information.
The adrenal glands are a pair of triangular glands that sit on top of the kidneys. They are responsible for the release of several hormones that regulate metabolism, immune system function, and salt-water balance. They also help in the body’s response to stress.
Adrenal disease occurs when excessive hormones are produced and too little is produced.
Common adrenal gland problems include:
There are several reasons why the adrenal gland malfunctions.
Problems in the adrenal gland could be due to:
Adrenal gland closely works with the pituitary gland.
Adrenal disease can lead to serious complications and can dramatically affect quality of life.
People with problems with adrenal gland can present with a variety of symptoms including:
Some of adrenal diseases can be life threatening. It is therefore extremely important that appropriate investigations are done by an endocrinologist and treatment initiated soon.
Cushing’s syndrome is a condition which occurs when the body is exposed to high level of glucocorticoid (steroid) also commonly called cortisol for a long period. Increased steroid levels in the body may occur due to several reasons, including:
Excess steroids can lead to either or all of these features:
In addition to the above features mentioned, people who develop Cushing’s can have several symptoms and signs. These depend on the level of excess cortisol in the body and how long they have been around in the body. There is a condition called “cyclical Cushing’s”, where in the symptoms and signs of Cushing’s comes and goes and can be difficult to diagnose.
Some of the common and rare presentations are mentioned below:
Investigation is done to confirm a diagnosis of Cushing’s syndrome or Cushing’s disease. Thereafter test is done to identify the exact location in the body, which is causing Cushing’s.
This involves several blood tests and urine tests. Once baseline blood tests are done, further investigations include overnight dexamethasone suppression test and low and high dose dexamethasone suppressions test. Scans of the Pituitary, adrenal or other parts of the body if appropriate may also be requested.
Investigations is usually done to check if complications of Cushing’s syndrome are present. This includes tests to rule out diabetes, osteoporosis and other conditions which could result from Cushing’s.
Treatment of Cushing’s syndrome will depend on the source of excess cortisol production. Surgery may be undertaken to remove the tumour. If surgery does not help to remove the tumour radiotherapy may be considered. Sometimes radiotherapy alone may be the choice of treatment.
Medications to control cortisol production may be used before surgery or if surgery and radiotherapy is not considered.
Treatment will also be directed towards complications of Cushing’s syndrome.
In some people the tumour causing Cushing’s can affect other hormones, which will need to be addressed.
If Cushing syndrome is not promptly diagnosed and treated, several complications is known to occur, which include:
Please see an endocrinologist near you if you are concerned or suspect Cushing’s syndrome
Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate hormones like cortisol and aldosterone. Commonest form of adrenal insufficiency is Addison’s disease, also called primary adrenal insufficiency. If Addison’s disease is not identified and treated, adrenal crisis may occur, which is a life threatening condition.
Addison’s disease in most people is due to an autoimmune condition, however it may also result from infection, tumour or injury. In some people secondary adrenal insufficiency may occur, when their pituitary gland does not produce adequate hormone called ACTH (Adreno Cortico Trophic Hormone). ACTH produced by pituitary gland stimulates the adrenal gland to produce cortisol.
If the above symptoms are not treated promptly, adrenal crisis may result with a drop in blood pressure and can be life threatening.
Your endocrinologist will arrange a number of blood tests and scans to ascertain if the problem is in the adrenal gland or pituitary gland. Also investigations will be arranged to find the underlying cause.
Treatment of Adrenal insufficiency (Addison’s disease) is replacement of deficient steroids.
A phaeochromocytoma (fee-o-kro-mo-sy-to-ma) is a rare, usually benign tumour that develops in an adrenal gland.
Phaeochromocytoma releases hormones that may cause high blood pressure, headache, sweating and palpitations. People with this tumour may complain of symptoms of a panic attack. Symptoms occur due to the release of hormones like adrenaline, noradrenaline and dopamine. It is known that these hormones are released at random, so the symptoms can vary and there is no pattern to how people get affected. If pheochromocytoma is not diagnosed and treated, it can be life threatening and serious complications are seen.
Symptoms vary and as explained above these symptoms can occur at random intervals. Common symptoms of phaeochromocytoma include:
Certain conditions, activity or food can make these symptoms worse.
Certain food like chocolates, cheese, wine, some beers and smoked meat can worsen symptoms.
Your endocrinologist will arrange a series of blood and 24 hour urine test followed by scans and may also include specialised scans.
Genetic testing may also be conducted to check for any associated conditions. Family members may also be checked to see if it is genetically transmitted and ensure no one else is suffering from this condition.
There are several tumours which may co-exist in people with phaeochromocytoma, which include: neurofibromatosis and hereditary paraganglioma. Phaeochromocytoma in rare instances may be part of a condition called Multiple Endocrine Neoplasia (MEN) type 2.
Conn’s Syndrome (Primary hyperaldosteronism) is a condition where the adrenal gland produces too much of an hormone called aldosterone. Aldosterone is the hormone which controls sodium and potassium salts in the body and also balances the water content and blood pressure. Conn’s syndrome was thought to be rare but it is now known to occur in as many as 5-15% of people with high blood pressure (Hypertension).
Most common cause is due to benign tumours of one or both the adrenal glands. Rarely cancerous lesion of adrenal can also produce excess amount of aldosterone. Some type of Aldosteronism or excess aldosterone production by adrenal gland is also known to run in families.
Symptoms of Conn’s syndrome can be subtle. Conn’s syndrome is usually suspected when some one has high blood pressure and an underlying cause is being investigated. Common symptoms of Conn’s syndrome include:
Generalised weakness
Muscle cramps
Excessive thirst
Frequent urination
Bloated abdomen
Weak bowel movements/Abdominal pain due to low potassium
High blood pressure which may lead to heart failure, stroke, kidney failure and changes in the retina.
Your endocrinologist will arrange a number of blood tests to check for salts and hormones in the body. This is followed by scans to confirm the diagnosis.
Treatment involve medications like spironolactone which not only corrects potassium levels but also controls hypertension. It is important that blood pressure is controlled. Some patients will also be offered surgery of the adrenal gland
If the aldosterone is coming from a tumour in one adrenal gland they can potentially be cured by removal of the adrenal gland tumour.
If Conn’s syndrome is not treated appropriately, low potassium can lead to increasing weakness and some people may have irregular heart rhythm.
High blood pressure due to Conn’s syndrome if not corrected can lead to stroke, heart attack, kidney failure and atrial fibrillation or AF.
Dr Chinnadorai Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. As a private endocrinologist he has private endocrine, diabetes and weight loss clinics in Harley Street, London, Chennai (India), Claremont Hospital, Sheffield, Nuffield Hospital, Leeds and Simplyweight, Bradford.
He has face to face consultations with people from Barnsley, Rotherham, Chesterfield, Doncaster, Wakefield, Huddersfield, Bradford, Harrogate, Leeds, Sheffield, London and Chennai (India). He also offers video consultations.
