Saanichton, BC

Dr. Miguel A. Lipka

Adrenal Disorders

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The adrenal glands, located above the kidneys, secrete hormones essential for the body's normal processes. The center of the gland is called the adrenal medulla, which secretes hormones such as epinephrine, also called adrenaline, that affect heart rate, blood pressure and sweating.

The adrenal cortex is the outer layer of the adrenal gland and produces hormones such as cortisol and aldosterone that control blood pressure, levels of salt and potassium in the body as well as the body's use of fats, proteins and carbohydrates. The adrenal cortex also produces some male sex hormones, such as testosterone.

Adrenal disorders can occur when the adrenal glands either produce excessive or inadequate amounts of hormones. These conditions include:

  • Adrenal insufficiency
  • Cushing's syndrome
  • Pheochromocytoma

If left untreated, these disorders can cause health problems such as high blood pressure and heart disease. Fortunately, they usually can be treated successfully.

Cushing's Syndrome

Cushing's syndrome is a rare hormonal disorder that occurs when the body's tissues are exposed to excessive levels of the hormone cortisol for a long period of time. Cortisol is produced by the adrenal glands and helps the body respond to stress, such as surgery and illness, and recover from infections. The hormone also helps maintain blood pressure and cardiovascular function and regulate the metabolism of proteins, carbohydrates and fats.

Benign, or non-cancerous, tumors of the pituitary gland called pituitary adenomas that secrete excessive amounts of adrenocorticotrophic hormone (ACTH) cause an estimated 70 percent of Cushing's syndrome cases in adults and is referred to as Cushing's disease. Other causes include tumors of the adrenal glands, which are located above the kidneys, as well as tumors occurring elsewhere in the body, such as the lungs, that secrete ACTH. This condition is known as ectopic ACTH syndrome. Rarely, some people may have an inherited tendency to develop tumors of one or more endocrine glands that can lead to Cushing's syndrome.

Cushing's syndrome is relatively rare, each year affecting only about 10 to 15 out of every million people. It most commonly occurs in adults between 20 and 50 years of age, with women accounting for over 70 percent of those diagnosed.

Symptoms of Cushing's syndrome may include:

  • Change in body form, particularly weight gain in the face (moon facies) as well as fat deposition above the collar bone, called supraclavicular fat, and at the back of neck, called a buffalo hump.
  • Skin changes with easy bruising, purplish stretch marks, called stria, and red cheeks
  • Excess hair growth on face, neck, chest, abdomen and thighs
  • Overall weakness and fatigue
  • Loss of muscle bulk
  • Decreased fertility and/or sex drive
  • Menstrual disorders in women
  • Hypertension
  • Diabetes mellitus
  • Depression with wide mood swings

Treatment of Cushing’s syndrome can vary depends on the cause of cortisol excess. People with Pituitary Adenomas can treated with several kinds of treatments. Most preferably is to use a surgical method called transphenoidal adenomectomy. Radiotherapy could be used to treat the disease in people who do not qualify for surgery or were unsuccessful with other treatments.

People who have an Adrenal tumor as a result of Cushing syndromes can use a procedure called laparoscopic adrenalectomy. It is only use for Adrenal tumors that are less than 6 cm. This treatment is strongly recommended because the patient can recover much quicker and experience less pain than other open procedures.

Adrenal Insufficiency

The adrenal glands, located above the kidneys, secrete many hormones essential for the body's normal functions. People with adrenal insufficiency do not produce enough of two vital hormones, called cortisol and aldosterone. Cortisol's most important function is to help the body respond to stress, such as surgery and illness, and recover from infections. The hormone also helps maintain blood pressure and cardiovascular functions and regulate the metabolism of proteins, carbohydrates and fats. Aldosterone regulates the amount of salt, potassium and water in the body, maintaining the proper balance.

Men and women of all ages are equally affected by adrenal insufficiency, which may be permanent or temporary and can be treated with medications. Causes of the permanent form of the condition include Addison's disease, congenital adrenal hyperplasia, complete surgical removal of the pituitary gland or the adrenal glands. Temporary adrenal insufficiency can be caused by physical stress, infections, surgery or failure to take corrective medication.

The symptoms of adrenal insufficiency usually begin gradually. Early symptoms may include:

  • Unusual fatigue and muscle weakness
  • Dizziness when standing
  • Nausea, vomiting and/or diarrhea
  • Loss of appetite
  • Stomachache

Symptoms that may occur in the later stages of the disease include:

  • Weight loss
  • Dark tanning of the skin
  • Craving for salt

Treatments vary depending on the hormone the patient is deficient in and the level of crisis.

Adrenal crisis

  • Intravenous fluid
  • Intravenous steroid, later hydrocortisone, prednisone or methylpredisolone tablets
  • Rest

Cortisol deficiency (primary and secondary)

  • Adrenal cortical extract
  • Hydrocortisone
  • Prednisone
  • Prednisolone
  • Methylprednisolone
  • Dexamethasone

Mineralcorticoid deficiency (low aldosterone)

  • Fludrocortisone (to balance sodium, potassium and increase water retention)

Pheochromocytoma

Pheochromocytoma is a rare tumor that usually develops from one of the body's two adrenal glands, which are located above each kidney in the back of the upper abdomen. The cancer usually develops in the central part of the adrenal glands called the adrenal medulla, which is responsible for producing important hormones such epinephrine, adrenalin, norepinephrine and dopamine. Pheochromocytomas often secrete too much hormone, which can cause high blood pressure, palpitations and headaches. High blood pressure that is left untreated can cause heart disease, stroke and other major health problems. Pheochromocytoma may occur as a single tumor or as multiple growths. Those that develop outside the adrenal glands are called paragangliomas.

About 10 percent to 15 percent of pheochromocytomas are malignant, or cancerous, with the potential to spread to other parts of the body. It is seen in both sexes and usually between the age of 30 and 40.

Symptoms of pheochromocytoma result from excessive hormone production and include:

  • Headaches that typically are severe
  • Accelerated or racing heartbeat, called tachycardia, and palpitations
  • Excessive sweating
  • Heat intolerance
  • Anxiety and/or nervousness, such as feelings of impending death
  • Nervous shaking or tremors
  • Pain in the lower chest or upper abdomen
  • Nausea with or without vomiting
  • Weight loss

There are many ways to treat the pheochromocytoma, including:

  • Surgery - one or two adrenal glands can be removed (adrenalectomy)
  • Chemotherapy
  • Radiation therapy

Pheochromoctoma has no methods for prevention.