Symptoms of Adrenal Gland Hormone Issues in Elderly Females
Elderly women with adrenal hormone disorders most commonly present with fatigue, weight changes, gastrointestinal symptoms, and cardiovascular manifestations, with the specific symptom pattern depending on whether there is hormone excess or deficiency.
Adrenal Insufficiency (Hormone Deficiency)
Primary Symptoms
- Profound fatigue and lethargy affecting 50-95% of patients, often the most debilitating symptom 1
- Nausea, vomiting, and decreased appetite occurring in 20-62% of cases 1
- Unintentional weight loss present in 43-73% of patients 1, 2
- Skin hyperpigmentation (darkening of skin in uneven distribution), which is specific to primary adrenal insufficiency and helps distinguish it from secondary causes 3, 4
Additional Manifestations
- Muscle weakness particularly affecting large joints and proximal muscles 2, 4
- Hypotension and orthostatic symptoms including dizziness upon standing 3
- Salt craving due to mineralocorticoid deficiency in primary adrenal insufficiency 3
- Depression and poor mental concentration 3
- Morning nausea that may improve after taking medication 3
Laboratory Abnormalities (Often Asymptomatic)
- Hyponatremia (low sodium), though levels may be only marginally reduced 3
- Hyperkalaemia (high potassium) in approximately 50% of cases at diagnosis 3
- Hypoglycemia, particularly in children but rarely in adults 3
- Mild hypercalcemia in 10-20% of patients 3
Cushing's Syndrome (Cortisol Excess)
Cardinal Features
- Rapid central weight gain with characteristic fat distribution in face ("moon face"), upper back (dorsal fat pad), and above collarbones 3
- Proximal muscle weakness affecting ability to rise from chairs or climb stairs 3
- Wide violaceous striae (purple stretch marks >1 cm wide) 3
- Depression and mood changes 3
Associated Findings
- Hyperglycemia and new-onset or worsening diabetes 3
- Hypertension that may be difficult to control 3
- Hirsutism (excess facial/body hair) 3
- Thin, fragile skin with easy bruising (petechiae and ecchymoses) 5
- Osteoporosis leading to fractures 6
Primary Aldosteronism (Conn Syndrome)
Primary Manifestations
- Hypertension often resistant to standard treatment 3, 7
- Muscle weakness due to potassium depletion 3, 7
- Hypokalemia causing metabolic alkalosis 3, 7
- Cardiac arrhythmias secondary to electrolyte disturbances 3
Pheochromocytoma (Catecholamine Excess)
Classic Triad
- Paroxysmal or sustained hypertension with dramatic blood pressure variability 3, 6
- Severe headaches occurring in episodes 3, 6
- Palpitations and tachycardia 3, 6
Additional Symptoms
- Profuse sweating during episodes 3, 6
- Pallor during attacks 3
- Orthostatic hypotension between episodes 3
- "Spells" or crisis episodes with multiple symptoms occurring together 3
Congenital Adrenal Hyperplasia (Rare in Elderly)
11-Beta-Hydroxylase Deficiency
17-Alpha-Hydroxylase Deficiency
- Primary amenorrhea (though this would have presented earlier in life) 3
- Incomplete sexual development 3
Age-Specific Considerations
In elderly women, adrenal androgen production (DHEA and DHEAS) is naturally reduced by approximately 50% compared to younger women, which may contribute to fatigue and decreased well-being 9. This physiologic decline can make distinguishing pathologic adrenal insufficiency more challenging, as baseline symptoms may overlap.
Critical Warning Signs Requiring Urgent Evaluation
- Acute adrenal crisis symptoms: severe hypotension/shock, altered mental status, severe abdominal pain, profound weakness, and vomiting 3, 1
- Rapid symptom progression over days to weeks 3, 10
- Symptoms triggered by stress, illness, or surgery in someone with known or suspected adrenal insufficiency 3, 1
Important Clinical Pitfalls
The nonspecific nature of adrenal insufficiency symptoms (fatigue, nausea, weight loss) often leads to delayed diagnosis, with patients sometimes presenting in acute crisis as their first manifestation 10. Clinicians should maintain high suspicion in elderly women with unexplained fatigue, weight loss, and hypotension, particularly if accompanied by hyponatremia 3. Conversely, many adrenal tumors in elderly women are discovered incidentally on imaging and may be asymptomatic despite having subclinical hormone excess 6.