Adrenal Disorders
Adrenal Disorders are the result of glands making too much, or not enough of certain hormones. These are caused by problems with the gland themselves, that cause overproduction or underproduction of hormones. They are also caused by problems in other glands, such as pituitary gland. Genetics can also play a role in certain adrenal disorders. In many cases, no one knows just why the disorders develop.
The Small glands on top of each kidney are known as adrenal glands. They generate hormones which are crucial for survival : cortisol and aldosterone. It also secretes adrenaline which is essential for the fight, flight and fright response.
The adrenal cortex produces:
Mineralocorticoids/Aldosterone: Helps control the handling of sodium and potassium in the kidney that influences blood pressure and volume of fluid.
Glucocorticoids/Cortisol: Responsible for assisting in the metabolism of glucose, inflammatory and immune response to disease or injury and controlling blood pressure and cardiac output.
Adrenal Androgens: Contains DHEA-, DHEA, testosterone and androstenedione, both of which contribute to the production of male characteristics in men; they play a diminished role in women, contribute to libido and function as precursors to estrogen.
Types of Adrenal Disorders
Adrenal Insufficiency(Addison’s Disease)
This happens when one or more of the adrenal glands are defective and don't contain enough hormones. Any or more of the hormones released by the adrenal cortex may be released in insufficient amounts, depending upon the cause. While the adrenal medulla can also be affected, catecholamines are still released by the nervous system in appropriate quantities for the body.
This may be attributed to an adrenal gland condition called primary adrenal insufficiency itself. Alternatively, the capacity of the adrenal glands to work can have an external influence adversely affecting. This is called secondary adrenal insufficiency, where the problem lies in the pituitary gland. Theremay also be a defect in the synthesis of the hormones due to enzyme deficiencies like in Congenital Adrenal hyperplasia (CAH).
Diagnosis is made by simple blood tests, mostly taken after an injection to stimulate the adrenal gland. Imaging like CT/MRI are rarely required. Patents diagnosed with adrenal insufficiency need to take life-saving steroid +/_ mineralocorticoid tablets for the rest of their life. They also need to double their steroid dose in case of illness.
The resulting symptoms may present as
- Generalised chronic weakness, fatigue, lethargy
- Increased sleepiness
- Low mood and desire
- Growth failure in children
- Aches and pains all over
- Inability of recover from a concurrent illness
- Low blood pressure and low blood sugar
- Inability to conceive in women (CAH)
- Excess facial hair in women (CAH)
Adrenal hormone Excess
This can happen due to a tumour of extra tissue in the adrenal gland which secretes the respective hormone in excess quantity. An excess of cortisol causes Cushing’s syndrome which can lead to many symptoms and signs in the body as illustrated in the picture. An excess of aldosterone causes the body to retain more water and sodium and excrete more potassium. This leads to weakness and hypertension.
Adrenal disorders require thorough endocrine blood testing under the supervision of an Endocrinologist. A CT/MRI scan of the adrenal is often required. Treatment is usually by surgery to remove the tumour or sometimes by medication alone.
Common Types of Adrenal Disorders
Addison’s Disease: This is also called Adrenal insufficiency. In this disorder, you don’t produce enough cortisol 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.
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.
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. Adrenal disorders can happen to anyone within the individual conditions, some of them may happen often to females than males, such as cushing’s syndrome.
