From the Guidelines
Diseases of the adrenal glands involve abnormal function of these hormone-producing organs, and the most recent and highest quality study recommends a comprehensive approach to diagnosis and management, prioritizing patient outcomes and quality of life. The adrenal glands consist of two parts: the cortex (outer layer) and medulla (inner core), each producing different hormones that can be affected by various disorders. Common adrenal diseases include:
- Cushing's syndrome (excessive cortisol)
- Addison's disease (insufficient cortisol and aldosterone)
- Pheochromocytoma (tumor causing excess adrenaline)
- Hyperaldosteronism (excess aldosterone)
- Adrenal insufficiency
These conditions typically present with symptoms like fatigue, weight changes, blood pressure abnormalities, and electrolyte imbalances. Treatment depends on the specific disorder but may include medications like hydrocortisone for Addison's disease (typically 15-25 mg daily in divided doses) 1, spironolactone for hyperaldosteronism (25-100 mg daily), or surgical intervention for tumors. Hormone replacement therapy is crucial for adrenal insufficiency, requiring lifelong treatment with careful dose adjustments during illness or stress.
According to the most recent study from 2023, patients with unilateral cortisol-secreting adrenal masses and clinically apparent Cushing's syndrome should undergo unilateral adrenalectomy of the affected adrenal gland, and minimally-invasive surgery (MIS) should be performed when feasible for these procedures 1. Additionally, the study recommends that patients with mild autonomous cortisol secretion who have progressive metabolic comorbidities attributable to cortisol excess can be considered for adrenalectomy after shared decision making.
The disorders arise from autoimmune processes, genetic factors, tumors, or medication effects that disrupt the delicate balance of hormone production. Early diagnosis through blood and urine tests, imaging studies, and sometimes genetic testing is essential for proper management and prevention of potentially life-threatening adrenal crises. The 2021 consensus on diagnosis and management of Cushing's disease also highlights the importance of accurate diagnosis, careful treatment selection, and management of the disease and its associated comorbidities to optimize patient outcomes 1.
In terms of follow-up, patients with primary adrenal insufficiency should be reviewed at least annually, with assessment of health and well-being, measurement of weight, blood pressure, and serum electrolytes, and occasional monitoring for the development of new autoimmune disorders 1. Overall, a comprehensive and multidisciplinary approach to the diagnosis and management of adrenal gland diseases is crucial to improve patient outcomes and quality of life.
From the Research
Overview of Adrenal Gland Diseases
- Adrenal gland diseases, such as Addison's disease, adrenal insufficiency, and primary aldosteronism, can have a significant impact on patient health and quality of life 2, 3, 4.
- These diseases can be caused by a variety of factors, including adrenal failure, hypothalamic-pituitary dysfunction, and excess cortisol, aldosterone, or catecholamines production 3.
Types of Adrenal Gland Diseases
- Addison's disease: a rare endocrine disorder characterized by the inadequate production of cortisol and aldosterone hormones 2.
- Adrenal insufficiency: a condition where the adrenal glands do not produce enough cortisol and/or aldosterone hormones, which can be primary (Addison's disease) or secondary (due to hypopituitarism) 4, 5.
- Primary aldosteronism: a condition where the adrenal glands produce too much aldosterone, leading to high blood pressure and low potassium levels 3.
- Adrenal incidentalomas: adrenal mass lesions >1 cm in diameter that are discovered incidentally by radiological examination, which can be benign or malignant 3.
Treatment and Management
- Conventional steroid replacement therapy for Addison's disease and adrenal insufficiency typically involves twice- or thrice-daily oral hydrocortisone and once-daily fludrocortisone 2, 5.
- New treatment modalities, such as modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion, have been developed to simulate the physiological serum cortisol rhythm more closely 2.
- Treatment of adrenal insufficiency should also consider the patient's individual needs, including cortisol rhythmicity and treatment of concomitant conditions, to improve outcomes and quality of life 4, 6.
Quality of Life and Outcomes
- Patients with adrenal insufficiency, despite standard glucocorticoid replacement therapy, often experience impaired self-perceived health status and quality of life 4, 6.
- Morbidity and mortality remain high in patients with adrenal insufficiency, with increased exposure to cortisol and insufficient cortisol coverage during infections and other stress-related events contributing to adverse outcomes 5.