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Adrenal Gland Disorders

The adrenal glands are responsible for many processes in the body. When functioning correctly, they produce various hormones that trigger chemical activity in every system. But what happens when disorders, such as Cushing's syndrome, interfere with those hormonal mechanisms? The following information should help you discuss the adrenal gland and its complex, interrelated disorders with your physician.

What are adrenal glands?

Located on top of both kidneys, the adrenal glands are triangular-shaped and measure approximately half an inch in height and three inches in length. The inner part ( adrenal medulla ) of the adrenal glands secretes hormones such as adrenaline that affect blood pressure, heart rate and sweating. The outer part ( adrenal cortex ) secretes many different hormones that control the use of fats, proteins and carbohydrates in the body. The cortex also secretes male sex hormones as well as mineralocorticoids that control blood pressure and the levels of salt and potassium in the body.

What can go wrong with adrenal glands?

If the adrenal glands are not functioning correctly the cause could be outside the gland. For instance, the hypothalamus , a part of the brain, or pituitary glands could fail to produce hormones that control the adrenal glands. A problem inside the adrenal gland could be caused by some kind of disease or infection in or around the gland. Major problems occur when the adrenal glands produce too many or too few hormones.

Cushing's syndrome: Cushing's syndrome refers to a complex set of symptoms and physical abnormalities caused by excess cortisol in the body. Most prevalent in adults between the ages of 20 and 50, it occurs when too much cortisol is produced in the adrenal glands. It can also be caused by excessive or prolonged use of steroids .

Prolonged natural production of cortisol can be linked to various sources, the most common of which is a tumor of the pituitary gland. The tumor stimulates overproduction of corticotrophin, also called adrenocorticotropic hormone ( ACTH ), a kind of pituitary control switch that governs growth and activity of the adrenal glands. Excesses of corticotrophin activate adrenal gland overgrowth, lead to excess cortisol secretion. This is referred to as Cushing's syndrome. This pituitary hyper secretion of corticotrophin accounts for 75 to 85 percent of all Cushing's cases. Other sources include adrenal tumors and ectopic ACTH , in which the hormone is overproduced by malignant tumors elsewhere in the body. The other 15 to 25 percent are due to adrenal cortical tumors.

Cushing's sufferers can be identified by their characteristic "moon" faces (round and full) and "buffalo" humps (fat collected between the shoulders). The disorder is marked by many other symptoms, the most common of which are obesity (90 percent), hypertension (80 percent), diabetes (80 percent), weakness (80 percent), excessive body hair (70 percent) and menstrual abnormalities/sexual dysfunction (70 percent).

A diagnosis of Cushing's syndrome is based on medical history, physical examination and laboratory tests to determine cortisol overproduction. Patients are usually asked to collect a 24-hour urine sample to be screened for high levels of the hormone.

Once the syndrome has been diagnosed, imaging and other tests may be ordered to identify the exact cause. A CT scan or MRI may be used to evaluate any pituitary or adrenal tumors. Both imaging techniques produce cross-sectional views of the body, but use different technologies. In either case, the test is painless, accurate and quick.

Cancer of the adrenal gland: Also characterized by overproduction of hormones, adrenal gland cancers are very rare afflicting only one or two per one million people. When they occur, however, these tumors may secrete excess amounts of cortisol or other adrenal products. For example, virilizing (masculizing) hormones are often produced. The symptoms you might experience are related to those hormones. For instance, a malignancy in the cortex an adrenocortical carcinoma  produces symptoms similar to Cushing's syndrome: high blood pressure, weight gain, excess body hair, osteoporosis and diabetes.

Diagnosis for adrenal cancer usually begins with blood tests to evaluate levels of certain hormones, including cortisol, dehydroepiandrosterone (DHEA) and testosterone . It may also include MRI and CT scans to determine the extent of the disease.

Pheochromocytoma: Usually benign , pheochromocytoma refers to a rare tumor of the medulla that secretes excessive amounts of the hormones epinephrine and norepinephrine , resulting in high blood pressure. An estimated 800 cases are diagnosed yearly in the United States, making it extremely rare.

The most common symptoms are headache, heart palpitations and excessive and inappropriate perspiration. Less commonly encountered symptoms include nervousness and anxiety, tremor, paleness, nausea, weakness, chest or abdominal pains, fatigue and weight loss.

Pheochromocytoma tumors occur in less than 1 percent of hypertensive patients and 90 percent of them are benign. Experts recommend that all hypertension sufferers be screened with blood or urine tests for overproduction of catecholamines or their metabolites since pheochromocytoma tumors secrete these neurotransmitter hormones in excess. In fact, checking for high levels of adrenaline or cortisol is usually done for adrenal malignancies of both the medulla and cortex . In either case, further CT scans or MRI will help your doctor determine the location and extent of the disease.

Pheochromocytoma can be life threatening if untreated and can cause stroke or damage to the kidneys, brain or heart. Drugs are available to control symptoms prior to tumor removal.

Hyperaldosteronism: The disorder, hyperaldosteronism, is defined by the body's overproduction of aldosterone, a hormone that controls sodium and potassium levels in the blood. The overproduction of aldosterone leads to hypertension .  Exceedingly rare, most cases occur in women, ages 30 to 50. The condition results from a benign tumor of the adrenal gland and occurs more frequently in women than men. It leads to potassium loss and increased sodium re absorption by the kidneys.

There are two types of hyperaldosteronism. It can occur from an abnormal growth ( hyperplasia ) in both adrenal glands or from a benign tumor of one of the adrenal glands.

The primary symptom of hyperaldosteronism is moderate hypertension. In addition, a patient may experience reduced blood pressure when a person stands after lying down. Constipation, muscle weakness (especially in the legs), excessive urination, excessive thirst, headache and personality changes are also possible symptoms. Some patients will show no obvious symptoms.

When hyperaldosteronism is suspected, blood and urine tests may be conducted to check for a high level of aldosterone and low levels of potassium and renin activity. A CT scan is also ordered to detect the side of an adenoma or bilateral hyperplasia .

How are adrenal gland disorders treated?

Cushing's syndrome: Treatment for Cushing's syndrome depends on successfully identifying the underlying cause of cortisol overproduction (e.g., an adrenal or pituitary tumor ) and removing it. If your disorder is a spin-off from long-term use of glucocorticoid hormones (e.g., prednisone) for another disease, your doctor may reduce or discontinue the dosage. But if it is linked to an underlying benign or malignant adrenal tumor, the growth will be removed surgically.

Pituitary adenoma: Transsphenoidal adenomectomy is the most widely-employed technique to remove a benign, corticotrophin-secreting pituitary tumor. This procedure relies on a microscope and small instruments to remove the gland through a nostril or opening below the upper lip. While the technique is extremely delicate, cure rates can be as high as 80 percent if performed by an experienced surgeon. But, if the procedure fails, or produces only a temporary cure, it can be repeated. Your doctor, however, may also prescribe radiation, especially if you are not an adenomectomy candidate. Improvement with radiation occurs in 40 to 50 percent of adults and 80 percent of children.

Adrenal benign and cancerous tumors: Benign or cancerous adrenal tumors are removed by an adrenalectomy , which is surgical removal of the entire gland. If the growth is small, your doctor will perform a laparoscopy , working through a small incision in the abdominal wall utilizing fiber-optic instruments. He or she will use an open surgical technique in selected cases. You may need follow-up chemotherapy if there is adrenal carcinoma .

Pheochromocytoma: Controlling high blood pressure with medications is the first step in treating pheochromocytoma . Once stabilized, the abnormal adrenal gland may be removed either through a laparoscopic or "open" surgical technique.

Hyperaldosteronism: Treatment for Conn's syndrome resulting from a solitary tumor centers on removing the growth by laparoscopic surgery. Individuals who have persistent high blood pressure after the procedure may require antihypertensive medication. If bilateral hyperplasia is the cause of hyperaldosteronism, the focus is on treatment with specific medications that block the effect of aldosterone .

What can be expected after treatment for adrenal gland disorders?

Cushing's syndrome: If you have Cushing's syndrome , your prognosis is linked to the underlying cause of cortisol overproduction. Treatment usually leads to significant improvement, even cure for a significant number of sufferers. But certain tumors may recur. The cure rate for adrenal malignancies , for instance, is less than 50 percent, even in patients with localized disease that can be removed. Conversely, the prognosis for adrenal adenomas is excellent. Additionally, surgical removal of the glands may lead to full recovery from pituitary Cushing's even though that tumor also may recur.

Adrenal cancer: Surgery for adrenal cancer may be followed by chemotherapy . Because treatment removes the source of many important hormones, you may need hormonal supplements. If the malignancy returns or spreads, you may require additional surgery or chemotherapy. The prognosis for adrenal cancer is poor. The five-year survival rate for adrenal cancer is 10 to 35 percent.

Pheochromocytoma: Without adequate treatment, the severe high blood pressure associated with pheochromocytoma can lead to heart attack or stroke. After treatment, the outlook is good for most patients. However, hypertension may return and must be controlled with medication. Rarely, pheochromocytomas are malignant and recur.

Hyperaldosteronism: With early diagnosis and treatment, prognosis for primary hyperaldosteronism is good.

Frequently asked questions:

Is Cushing's syndrome inherited?

Most cases are not inherited. In rare instances, however, individuals may have a hereditary predisposition to an endocrine tumor that could cause Cushing's syndrome .

Can Cushing's syndrome be prevented?

No. There is no known prevention for Cushing's syndrome.

What is the pituitary gland and how does it work?

Located at the base of the head, the pituitary gland is the most important part of the endocrine system . Despite its small size, the pituitary gland is often referred to as the master gland because it regulates the activity of other endocrine glands and body processes. Specifically, it secretes corticotrophin, which stimulates the adrenal glands to activate other hormones, which initiate multiple chemical activities.

What are incidentally discovered adrenal masses and how are they treated?

Incidentally discovered adrenal masses show up accidentally on one to two percent of all CT scans and MRI s. They are managed based on their origin. For instance, cystic (or fluid-filled) growths are observed until increased size suggests removal; solid or dense lesions larger than five centimeters are removed immediately.

What is secondary hyperaldosteronism?

Secondary hyperaldosteronism is generally related to hypertension and is often tied to disorders such as renal artery disease , cardiac failure, liver disease and nephrotic kidney syndrome . In each case, the disease itself causes elevated aldosterone . The prognosis, after treatment with medications and diet, depends on the primary disease.

Reviewed: January 2011

Last updated: April 2013

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Adrenal Gland Disorders Glossary
  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • ACTH: Also known as adrenocorticotropic hormone or corticotrophin. Hormone produced by the pituitary gland that stimulates the adrenal cortex to produce steroid hormones.

  • adenoma: A benign (non-cancerous) tumor that arises in or resembles glandular tissue.

  • adenomectomy: Surgical removal of a gland.

  • adrenal: Glands that reside above the kidneys composed of an inner medulla and an outer cortex.

  • adrenal adenoma: Common, benign (non-cancerous) tumor arising from the cortex (out layer) of the adrenal gland.

  • adrenal cancer: Cancer of the adrenal glands.

  • adrenal carcinoma: Cancer of the adrenal cortex.

  • adrenal cortex: The outer layer of the adrenal gland.

  • adrenal gland: One of a pair of small glands, each of which sits on top of one of the kidneys. These glands produce hormones that help control heart rate, blood pressure, the way the body uses food and other vital functions.

  • adrenal medulla: Inner portion of the adrenal gland.

  • adrenal tumor: Abnormal mass of tissue or growth of cells in the adrenal glands.

  • adrenalectomy: Surgical removal of one or both adrenal glands.

  • adrenaline: Also known as epinephrine. Hormone secreted in the adrenal gland that raises blood pressure, produces a rapid heartbeat and acts a neurotransmitter when the body is subjected to stress or danger.

  • adrenocorticotropic hormone: Also known as ACTH. Hormone produced by the pituitary gland that stimulates the adrenal cortex to produce steroid hormones.

  • aldosterone: An adrenal hormone critical for salt (sodium) balance. Produced by the outer part of the adrenal cortex, its action causes a reabsorption of sodium and secretion of potassium and is critical for the maintenance of blood pressure.

  • antihypertensive: Preventing or reducing abnormally high blood pressure.

  • anxiety: A feeling of apprehension, often characterized by feelings of stress.

  • artery: Blood vessel that carries blood from the heart to various parts of the body.

  • benign: Not malignant; not cancerous.

  • benign tumor: Tumor that is non-cancerous. Generally do not spread to other organs or come back when they are removed.

  • bilateral: Term describing a condition that affects both sides of the body or two paired organs.

  • bilateral hyperplasia: Abnormal growth on one side.

  • cancer: An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.

  • carcinoma: Cancer that begins in the skin or in tissues that line or cover body organs.

  • catecholamine: Type of organic compound.

  • chemotherapy: Treatment with medications that kill cancer cells or stop them from spreading.

  • cortex: The outer layer of an organ.

  • cortisol: Primary stress hormone.

  • CT scan: Also known as computerized tomography, computerized axial tomography or CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • cystic: Used to describe a cyst or material that forms, contains or is enclosed in a cyst.

  • dehydroepiandrosterone: Also known as DHEA. A steroid hormone produced by adrenal glands and converted to other hormones like estrogen and testosterone.

  • DHEA: Also known as dehydroepiandrosterone. A steroid hormone produced by the adrenal glands and converted to other hormones like estrogen and testosterone.

  • diabetes: A medical disorder of increased blood sugar levels that can cause bladder and kidney problems.

  • diagnosis: The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).

  • ectopic: Used to describe an organ or body part occurring in a position or form that is not usual.

  • ectopic ACTH: When ACTH is produced outside the pituitary gland usually by a malignant tumor.

  • endocrine: Relating to glands that secrete hormones internally directly into the lymph nodes or bloodstream.

  • endocrine glands: Any gland of the body that secretes hormones directly into the lymph nodes or bloodstream.

  • endocrine system: System of glands that secrete hormones internally directly into the lymph nodes or bloodstream.

  • epinephrine: Also known as adrenaline. Hormone secreted in the adrenal gland that raises blood pressure, produces a rapid heartbeat and acts as a neurotransmitter when the body is subjected to stress or danger.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • gland: A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.

  • glucocorticoid: A steroid hormone that controls the metabolism of carbohydrates, proteins and fats.

  • high blood pressure: Medical term is hypertension.

  • hormone: A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.

  • hyperaldosteronism: Syndrome associated with increased production of the hormone aldosterone, a hormone that controls sodium and potassium levels in the blood.

  • hyperplasia: Excessive growth of normal cells of an organ.

  • hypertension: High blood pressure, which can be caused either by too much fluid in the blood vessels or by the narrowing of blood vessels.

  • hypertensive: Having high blood pressure.

  • hypothalamus: The area of the brain that controls body temperature, hunger and thirst.

  • incision: Surgical cut for entering the body to perform an operation.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • ions: Electrically charged atoms.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • kidneys: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • laparoscopic: Using an instrument in the shape of a tube that is inserted through the abdominal wall to give an examining doctor a view of the internal organs.

  • laparoscopic surgery: Surgery performed with an instrument in the shape of a tube that is inserted through small cuts. Using a small video camera and a few customized instruments, the surgeon can work in many body cavities without dividing skin from muscle thus reducing recovery time and complications.

  • laparoscopy: Surgery using an instrument in the shape of a tube that is inserted through the abdominal wall to give an examining doctor a view of the internal organs.

  • lesion: A zone of tissue with impaired function as a result of damage by disease or wounding. Examples are scars, abscesses, tumors and ulcers.

  • liver: A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.

  • malignancies: Cancerous growths.

  • malignancy: A cancerous growth.

  • malignant: A cancerous growth that is likely to grow and spread which can cause serious disablement or death.

  • malignant tumor: Refers to cancer. A new growth of tissue (tumor) in which the cells multiply uncontrollably, with a potential for spreading from one organ to other parts of the body and unless neutralized will eventually result in death.

  • medulla: The innermost area of an organ.

  • metabolites: Substances that are involved or are a byproduct of metabolism.

  • mineralocorticoids: A general term for the steroid hormones secreted by the adrenal cortex, which controls the excretion of salt and water.

  • MRI: Also referred to a magnetic resonance imaging. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

  • nephrotic kidney syndrome: A collection of symptoms that indicate kidney damage. Symptoms include high levels of protein in the urine, lack of protein in the blood, leg swelling and high blood cholesterol.

  • neurotransmitter: A chemical that carries messages between different nerve cells or between nerve cells and muscles.

  • norepinephrine: Hormone secreted by the adrenal gland. It increases blood pressure and rate and depth of breathing, raises blood sugar levels and decreases the activity of the intestine.

  • open surgical technique: Treating injuries or disorders of the body by making a large incision into the body and manipulating internal organs.

  • osteoporosis: A disease occurring among women after menopause or in men on hormonal therapy for prostate cancer in which the bones become very porous, break easily and heal slowly. Found in patients with Cushing's syndrome.

  • pheochromocytoma: A tumor of the adrenal gland, which is typically benign (non-cancerous).

  • pituitary: Relating to or produced by the pituitary gland.

  • pituitary gland: The main endocrine gland. It is a small oval shaped structure in the head and it regulates growth, sexual maturing and metabolism.

  • pituitary tumor: Abnormal mass in the pituitary gland.

  • potassium: An alkali element.

  • radiation: Also referred to as radiotherapy. X-rays or radioactive substances used in treatment of cancer.

  • renal: Pertaining to the kidneys.

  • renal artery: Main artery that supplies the kidney.

  • renal artery disease: Narrowing of the blood supply to the kidneys.

  • renin: A hormone made by the kidneys that helps regulate the volume of fluid in the body and blood pressure.

  • secretion: Process of producing a substance from the cells and fluids within a gland or organ and discharging it.

  • stent: With regard to treating ureteral stones, a tube inserted through the urethra and bladder and into the ureter. Stents are used to aid treatment in various ways, such as preventing stone fragments from blocking the flow of urine.

  • steroid: An organic fat-soluble compound.

  • testosterone: Male hormone responsible for sexual desire and for regulating a number of body functions.

  • tumor: An abnormal mass of tissue or growth of cells.

  • urate: A salt of uric acid.

  • urge: Strong desire to urinate.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

Adrenal Gland Disorders Anatomical Drawings

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