The adrenal glands are small triangular hat-shaped endocrine organs weighing about 4-6 grams, present above each of the kidneys. They are also known as suprarenal glands (supra=above, renal=kidneys).

What do adrenal glands do?

Adrenal glands are a part of the endocrine system. They secrete essential hormones in the body, directly into the blood. Each adrenal gland has two regions, namely the adrenal cortex and the adrenal medulla. The adrenal cortex and medulla carry out different functions of the body through their ability to produce various hormones. Table1 contains the role of these hormones. The pituitary gland or the master gland in the endocrine system regulates the functioning of the adrenal gland. In simple terms, the pituitary glands provide ‘direction’ of what has to be done by the adrenal gland.

Table 1: Key functions of Adrenal hormones

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What happens when the adrenal glands do not function properly?

Too much or too little of the adrenal hormones can lead to a group of disorders known as adrenal gland disorders. These conditions are unique to the hormones affected, impacting the healthy and normal functioning of the body.

Why do adrenal disorders occur?

The causes of adrenal disorders include:

Malfunctioning of the pituitary gland, which leads to the inability of the pituitary gland to instruct and control the adrenal gland
Tumours in the adrenal gland
Infections in the adrenal gland
Impact of certain medications or steroids
Genetic factors, leading to improper adrenal gland functioning

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What are the symptoms of adrenal gland disorders?

Although each condition may have its unique symptoms, the common adrenal disorder symptoms include:

Dizziness
Excessive tiredness
Sweating
Nausea and vomiting
Increased salt cravings
Low blood sugar
Low blood pressure
Irregular periods in females
Dark patches on your skin
Muscle and joint pain
Loss of appetite

These symptoms are known to be mild and rare at first, and over time become recurring and even worse. Hence, it is essential to consult a health care practitioner regarding the symptoms of adrenal disorders.

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What are the types of adrenal gland disorders?

The improper production of each hormone produced by the adrenal gland can lead to a specific type of disorder with a particular underlying cause. The most common types of adrenal gland disorders include:

Addison’s disease

Addison’s disease or primary adrenal insufficiency is a condition wherein there is inadequate production of cortisol and sometimes, aldosterone. The causes include autoimmunity (destruction of the adrenal gland by the body’s immune system) , tumours, genetic predisposition, infections, etc. They can be typically challenging to spot only via symptoms and need further investigation.

Cushing’s syndrome

Cushing’s syndrome is a condition wherein the adrenal gland produces too much of the hormone cortisol. It is due to adrenal gland hyperplasia or cortisol secreting tumours.

People with Cushing’s syndrome generally notice their face get plump, called as a moon face appearance. Besides, there is also unusual weight gain, easy bruising in the skin, a fatty hump visible between the shoulders and the presence of purple stretch marks on the body. Excess hair growth in females and low libido in males are also the symptoms of Cushing’s syndrome.

Excess intake of steroid containing medication can also lead to a Cushing type syndrome.

Pheochromocytoma

Pheochromocytoma is a condition of the adrenal medulla, the central part of the adrenal gland. It leads to overproduction of catecholamines namely-adrenaline or noradrenaline.

Patients with Pheochromocytoma generally have high blood pressure. Other associated symptoms include headaches, panic-like symptoms, sweating, tremors, paleness on the face and shortness of breath. The symptoms can vary among individuals, depending on the size of the tumour. These symptoms can occur suddenly, like an attack, several times a day or occur rarely, couple of times a month.

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How to diagnose adrenal disorders?

Along with a detailed medical history, and a thorough clinical examination, clinicians call for blood tests, urine tests and imaging tests to diagnose adrenal disorders.

Blood and urine tests: These tests measure and evaluate the level of adrenal hormones as well as pituitary hormones. They also help assess blood glucose levels and sodium levels.
Imaging tests: Ultrasound, CT, MRI and X-ray imaging take pictures of the adrenal gland. They help detect possible tumours, impact on the gland and other signs of disease.

How to treat adrenal gland disorders?

The treatment of adrenal disorders is generally associated with the cause of the disease and aimed at normalising the adrenal hormone levels in the body.

Medication therapy: Commonly, low adrenal function conditions like Addison’s disease is treated with hormone replacement therapy to increase and normalise the hormone levels in the body. Moreover, medications help decrease cortisol production in the adrenal glands or inhibit the influence of cortisol in conditions like Cushing’s syndrome.
Surgery: Surgical interventions help in removal of the tumour. However, they depend on the type, size and extent of the tumour. Sometimes, surgeries are performed when other treatment options fail to show results.
Other treatment options include radiation therapy and chemotherapy, based on the underlying cause. There are also combinations of the above treatments tried by doctors, depending on the condition. Also, medications may help control symptoms such as high blood pressure and fatigue.

During treatment, other organs such a pancreas, sex organs, thyroid organs and pituitary gland may be evaluated, to look for the impact of the improper functioning of the adrenal gland on them.

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What are the complications of adrenal disorders?

Adrenal disorders may harm the overall healthy functioning of the body. These primarily include:

Muscle weakness
Behavioural disturbances, such as emotional liability and sometimes depression
Adrenal crisis

What is an acute adrenal crisis?

Acute adrenal crisis is a potentially life-threatening medical emergency. It occurs due to an extreme shortage or insufficiency of the cortisol hormone. The cause of the adrenal crisis can be any of the following:

Presence of an adrenal gland disorder/malfunction such as Addison’s disease or CAH
Improper functioning of the pituitary gland leading to inactivation of the adrenal gland
Change in medications or their dose
Dehydration
Stress
Infections

It exhibits symptoms such as abdominal pain, dizziness, loss of consciousness, fatigue, headache, high fever, loss of appetite, nausea, vomiting, excessive perspiration etc. among others. It is essential to recognise these symptoms and seek immediate medical attention to avoid delay of treatment. Potential complications include shock, coma and seizures.

Prevention

People with Addison’s Disease should be trained to recognize signs of stress that may cause acute adrenal crisis
In most cases, a patient might need to self-medicate with prescribed medications in times of stress
Patients suffering from Addison’s Disease are always recommended to carry their medical card with details and dose of medication needed in case of emergency

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What are adrenal cancers?

Adrenal cancers are rare but aggressive cancers of the adrenal gland leading to excessive production of all the adrenal hormones.

Primary adrenal cancers begin from within the adrenal gland, i.e., the cortex or the medulla. They tend to spread to other organs and cause grave changes within the body.
Secondary adrenal cancers arise from different parts of the body, such as the lungs, breast, and colon, rectum, etc. and spread to the adrenal gland. They are said to be more common than the primary variant.

The signs and symptoms of adrenal cancer may vary depending upon its impact on the hormones, size of the tumour and extent of spread of cancer.

What are the risk factors for adrenal cancer?

There is no single cause for the occurrence of adrenal cancers. It is primarily attributed to a genetic abnormality. Women have a slightly higher risk than men in developing adrenal gland cancer.

How to diagnose adrenal cancer?

The objective of diagnosis is to identify improper levels of adrenal hormones and identify structural abnormalities. Hence along with a comprehensive history and physical examination, clinicians call for blood tests, urine tests and imaging tests such as X-rays, CT, MRI, ultrasound and PET scans. Along with this, adrenal cancers may have a more comprehensive testing process to arrive at a diagnosis. Doctors may suggest a collection of biopsy with the help of a needle, called a fine needle biopsy. These samples are studied under a microscope to indicate the type, nature, grade and extent of cancer.

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How to grade and stage adrenal cancers?

The grade is a description of how the cancer cells look compared to healthy cells. Staging of cancers helps identify the extent of cancer spread in the body. Table 2 contains the grading and staging of cancers.

Table 2: Grading and staging of adrenal cancers

What is the prognosis of adrenal cancers?

The prognosis of the adrenal cancers is generally dependent on the stage, type and grade of cancer. A lower stage, functional type and lower grade of cancer have more favourable results. Unfortunately, due to the varied and delayed nature of the symptom manifestation, adrenal cancers are generally said to be detected at the later stages of the disease. Owing to the delay, they commonly invade nearby organs or spread to distant organs, making it more challenging to treat, impacting the prognosis of the disease.

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How to treat adrenal cancer?

Treatment of adrenal cancer usually includes any one or more of the following:

Surgery: The type of surgery is decided upon the size of the tumour and also where cancer has spread. For example, Adrenalectomy is a surgery to remove the entire adrenal gland. It is preferred when the cancer is localized in an adrenal gland.
Supportive medications: These medications are usually prescribed to control symptoms occurring as a result of too much hormone production or low hormone production post-surgery.
Chemotherapy: Usually used in patients, where cancer cannot be removed with surgery. It is also given in addition to surgery in some patients
Radiotherapy: External beam radiation therapy may be given after surgery in some, to reduce the risk of cancer coming back.

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References:

Adrenal gland disorders. MedlinePlus. https://medlineplus.gov/adrenalglanddisorders.html#cat_51. Accessed on March 23, 2020.
Adrenal disorders: Types. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16717-adrenal-disorders/types. Accessed on March 23, 2020.
Adrenal glands. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands. Accessed on March 23, 2020.
Adrenal glands. Healthline. https://www.healthline.com/health/adrenal-glands#disorders. Accessed on March 23, 2020.
Adrenal cancer. Healthline. https://www.healthline.com/health/adrenal-cancer. Accessed on March 23, 2020.

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