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Adrenal

What is Adrenal?

The adrenal glands are located above the kidneys. Their function is to make several kinds of hormones that control everything from salt balance to fight or flight response. Disorders of the adrenal glands are due to too much or too little production of these hormones.

Adrenal insufficiency

A deficiency of the hormone cortisol is called adrenal insufficiency. Cortisol has many functions in the body, including maintaining blood pressure, controlling inflammation, regulating blood sugar, and regulating the sleep-wake cycle. 

  • Symptoms of cortisol deficiency can include fatigue, lightheadedness, low blood pressure, abdominal pain, low blood sugar, poor appetite, weight loss, darkening of the skin, and sleep problems. 
  • Diagnosis: the first screening test is usually an 8 AM blood test for cortisol, which is expected to be highest in the morning. If this is abnormal or inconclusive, we may order a Cosyntropin stimulation test, which involves getting an injection of a high dose of hormone to stimulate the adrenal glands. If the cortisol is still low this confirms the diagnosis.
  • Treatment involves the replacement of cortisol with cortisol-like medications. The dose will be adjusted based on improvement in symptoms and blood tests for electrolytes.

A deficiency of the hormone aldosterone is also a rare form of adrenal insufficiency. Aldosterone regulates salt balance, working primarily in the kidneys.

  • Symptoms of aldosterone deficiency can include lightheadedness, low blood pressure, and high potassium.
  • Diagnosis: morning blood tests for aldosterone and renin can diagnose this condition.
  • Treatment involves the replacement of aldosterone with a medication similar called fludrocortisone and may include salt tablets.
Adrenal (cortisol) excess or Cushing’s syndrome

An excess of the hormone cortisol or cortisol-like hormones can be due to overactive adrenal glands, overactive pituitary gland, or medications like cortisol that are prescribed for other reasons. 

  • Symptoms: weight gain (particularly around the mid-section), muscle wasting, fatigue, depression, dark stretch marks, fat deposition behind the neck, recurrent infections, glaucoma and other vision problems, insulin resistance and/or diabetes, high blood pressure, swelling and fluid retention, and certain electrolyte abnormalities. 
  • Diagnosis: There are 3 tests for excess cortisol
    • Overnight dexamethasone suppression test: A pill call dexamethasone is taken once at bedtime, and you will go to the lab the next morning to test for cortisol and ACTH. A normal response is for both these hormones to be suppressed by the pill.
    • 24 hour urine cortisol: You will collect your urine for 24 hours to test for excess cortisol. Lab instructions and container will be given.
    • Midnight salivary cortisol: You will collect samples of saliva a midnight
  • Treatment of Cushing’s syndrome depends on the cause. If it is due to medications prescribed for other reasons, we will discuss if it is safe to reduce or stop these medications in conjunction with your other providers. If it is due to excess production by either the adrenal glands or pituitary gland, we will do more investigation to determine if surgery is indicated to remove the overactive gland. 

An excess of the hormone aldosterone is a rare cause of high blood pressure

  • Symptoms: High blood pressure, low potassium
  • Diagnosis: blood tests for aldosterone and renin
  • Treatment: medications to block the action of aldosterone, lower blood pressure
Pheochromocytoma

This is a very rare kind of malignancy due to overgrowth of the tissue that makes epinephrine (adrenaline), norepinephrine, dopamine, or other related hormones.

  • Symptoms are due to excess adrenaline and related hormones. They can include episodes of rapid heart rate, headache, flushing, anxiety, sweating, high blood pressure, and lightheadedness and fainting
  • Diagnosis starts with a 24-hour urine test for these hormones. If abnormal, imaging will be done
  • Treatment: surgery to remove the overactive tissue
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