The adrenal glands sit above the kidneys and make cortisol (the stress hormone), aldosterone (which controls salt and blood pressure), and adrenaline. Adrenal disorders are uncommon but important. Several of them are hidden causes of high blood pressure, diabetes or weakness, and some can be life-threatening if missed.
Conditions treated
- Cushing's syndrome (too much cortisol): weight gain in the face and abdomen, purple stretch marks, thin skin and easy bruising, muscle weakness, high blood pressure, high sugar and weak bones. The most common cause is long-term use of steroid medicines.
- Addison's disease and adrenal insufficiency (too little cortisol): tiredness, weight loss, poor appetite, low blood pressure, salt craving and darkening of the skin and gums.
- Primary aldosteronism: a common, treatable cause of high blood pressure, especially when blood pressure is hard to control or potassium is low.
- Phaeochromocytoma: a rare tumour causing episodes of headache, sweating, racing heart and very high blood pressure.
- Adrenal lumps (incidentalomas): lumps found by chance on scans done for other reasons. These need hormone tests to check whether they are active.
- Congenital adrenal hyperplasia in children and adults.
When to consult an endocrinologist
- High blood pressure that needs three or more medicines, starts at a young age, or comes with low potassium
- An adrenal lump on a CT or ultrasound scan
- Features of Cushing's syndrome, or long-term steroid use (including some "ayurvedic" or unlabelled medicines that may contain steroids)
- Unexplained tiredness, weight loss and low blood pressure
Never stop steroid tablets suddenly if you have taken them for more than a few weeks. This can cause an adrenal crisis, with vomiting, collapse and very low blood pressure, which is an emergency.
Tests
- Cortisol tests, such as the overnight dexamethasone suppression test, a morning cortisol test or an ACTH stimulation test
- The aldosterone-to-renin ratio
- Plasma or urine metanephrines
- A CT scan of the adrenal glands
Treatment
Treatment depends on the cause:
- Hormone replacement for adrenal insufficiency, with sick-day rules and an emergency card
- Medicines that block aldosterone
- Planned surgery for hormone-producing tumours, carried out with experienced surgeons
- Carefully tapering steroid medicines when they are the cause
Consulting Dr. Prasadh Rao L
Dr. Prasadh Rao L (MBBS, MD (General Medicine), DM (Endocrinology)) is an Assistant Professor of Endocrinology at Madras Medical College, where these conditions are seen and managed regularly. Treatment is planned individually, because the right choice depends on the cause, your age, other health conditions and your plans, such as pregnancy. Consultations are available at Dr. PD's Diabetes and Endocrine Speciality Clinic, Maduravoyal (Mon – Sat, 7:30 – 9:30 PM), at Dr. RK Podiatric Institute, Kolathur (4:00 – 6:30 PM), and by appointment at partner hospitals and clinics. See all locations or read the doctor’s profile.
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Written by Dr. Prasadh Rao L, MBBS, MD (General Medicine), DM (Endocrinology). Assistant Professor of Endocrinology, Madras Medical College. Tamil Nadu Medical Council Reg. No. 96520.
This article is for general information. It is not a diagnosis or a treatment plan. Please don't start, stop or change any medicine without speaking to your doctor.