What is an adrenal gland issue?

From the Guidelines

The adrenal glands are small, triangular-shaped endocrine organs located on top of each kidney that produce essential hormones including cortisol, aldosterone, and adrenaline, and issues with these glands can lead to disorders such as Addison's disease, Cushing's syndrome, and pheochromocytoma. These glands consist of two distinct parts: the outer cortex and inner medulla, each producing different hormones. The adrenal cortex produces steroid hormones like cortisol (which regulates metabolism and helps respond to stress), aldosterone (which regulates sodium and potassium balance), and small amounts of sex hormones 1. The adrenal medulla produces catecholamines like adrenaline and noradrenaline, which trigger the "fight-or-flight" response during stress. Common adrenal disorders include:

• Addison's disease (adrenal insufficiency), which is also called primary adrenal insufficiency (PAI) and is characterized by the lack of glucocorticoid and mineralocorticoid hormones 2
• Cushing's syndrome (excess cortisol), which can be caused by a benign adrenal tumor (adrenal adenoma) or a malignant adrenal tumor, and can also be caused by bilateral multinodal hyperplasia 1
• Pheochromocytoma (tumor causing excess catecholamines)
• Adrenal fatigue (controversial condition of chronic stress) Treatment depends on the specific condition but may include:
• Hormone replacement therapy
• Surgery, such as laparoscopic adrenalectomy for benign adrenal tumors or bilateral adrenalectomy for Cushing's syndrome 1
• Lifestyle modifications to manage stress Regular medical check-ups are important for those with adrenal concerns, as proper hormone balance is crucial for overall health and wellbeing. It is essential to evaluate and treat adrenal gland issues promptly to prevent complications and improve quality of life, and medical management of hypercortisolism is achieved with adrenostatic agents, including ketoconazole and mitotane, and bilateral adrenalectomy is recommended in some cases 1.

From the FDA Drug Label

Primary or secondary adrenocortical insufficiency Acute adrenocortical insufficiency Congenital adrenal hyperplasia

• An adrenal gland issue refers to a problem with the adrenal glands, such as: + Adrenocortical insufficiency: a condition where the adrenal glands do not produce enough hormones, including primary or secondary insufficiency + Acute adrenocortical insufficiency: a sudden and severe deficiency of adrenal hormones + Congenital adrenal hyperplasia: a genetic disorder that affects the production of adrenal hormones 3
• These issues can be caused by various factors, including genetic disorders, injury, or disease, and can lead to a range of symptoms and health problems.
• Adrenal insufficiency can be a life-threatening condition if left untreated, and requires careful management and treatment with hormone replacement therapy 4, 5

From the Research

Definition of Adrenal Gland Issue

• Adrenal insufficiency is characterized by inadequate glucocorticoid production due to destruction of the adrenal cortex or lack of adrenocorticotropic hormone stimulation 6, 7.
• It can be primary, where the adrenal gland is damaged, or secondary, where the pituitary gland or hypothalamus is affected 7.
• Adrenal insufficiency can cause non-specific symptoms, and early detection is crucial to prevent adrenal crisis 7, 8.

Causes and Diagnosis

• The most common cause of adrenal insufficiency is chronic glucocorticoid therapy 6.
• Primary adrenal insufficiency can be caused by autoimmune adrenalitis, while secondary adrenal insufficiency is often caused by pituitary tumors or their treatment 9.
• Diagnosis is made by demonstrating low basal and/or stimulated serum cortisol, and confirmatory testing can be done using the cosyntropin stimulation test or insulin tolerance test 7, 8.

Treatment and Management

• Maintenance glucocorticoid replacement is usually given as hydrocortisone, and patients with primary adrenal insufficiency also require mineralocorticoid replacement 6, 9.
• Patient education is essential to manage the condition and prevent adrenal crisis, which is a life-threatening medical emergency 6, 7, 10.
• Treatment of adrenal crisis involves prompt recognition, administration of parenteral hydrocortisone, rehydration, and management of electrolyte abnormalities 8, 10.