Excess or deficient secretion of adrenal hormones, as well as adrenal tumours, can cause a wide range of complaints — from high blood pressure to weight gain and fatigue. Below is a brief overview of the main symptoms, diagnosis and treatment of these conditions.
Cushing’s syndrome
Cushing’s syndrome develops when the adrenal glands produce too much of the hormone cortisol. It is a rare condition and occurs more often in women. The main causes are tumours of the pituitary and adrenal glands. It can also be caused by other substances that stimulate adrenal hormone secretion independently of the pituitary.
Complications may include cardiovascular disease, hypertension, diabetes, high cholesterol, obesity, osteoporosis, psychological disorders and recurrent infections.
Diagnosis involves measuring cortisol levels, a dexamethasone test, pituitary MRI and adrenal CT. Cushing’s syndrome caused by pituitary or adrenal tumours requires surgery.
After successful surgery, cortisol levels return to normal and symptoms resolve within 6–18 months.
Main symptoms (they may differ from person to person):
- weight gain
- high blood pressure (hypertension)
- a “moon-shaped” face, fat accumulation in the neck area
- stretch marks on the skin, facial redness
- excess facial and body hair in women
- high blood sugar
- muscle weakness, bone loss (osteoporosis)
- kidney stones
- depression and sleep disorders
Primary hyperaldosteronism
Some forms of hypertension can be treated without medication. One of them is hypertension caused by excess aldosterone. In other causes of high aldosterone, however, medication must be taken continuously. Specific tests are used to tell these forms apart. Low salt intake also raises aldosterone levels.
Aldosterone-related hypertension should be suspected in the following cases:
- severe fatigue and muscle cramps
- hypertension together with heart, kidney or neurological problems at a young age
- low blood potassium
- hypertension before the age of 30
- blood pressure that does not come down with 3 or more medications
- an adenoma found in the adrenal gland
Pheochromocytoma
Pheochromocytoma is a very rare cause of hypertension, but when treated in time blood pressure returns to normal, whereas without treatment it can be fatal. It is mainly caused by an adrenal tumour that secretes excessive adrenaline and noradrenaline, damaging the heart and blood vessels.
The main symptoms are episodes of palpitations, sweating, headache, facial pallor or flushing, and fluctuating blood pressure. Sometimes the condition is found without any complaints.
If it is suspected, blood and urine tests are performed. For accurate results, the medications you take should be stopped and a specific diet followed for 3 days before testing. Values 2–3 times above normal confirm the diagnosis; MRI is then used to locate the tumour.
Treatment is surgical removal of the tumour. Surgery should be performed in specialised hospitals, with the patient under special care and follow-up.
Adrenal adenomas and carcinomas
Most adrenal tumours (70–80%) are benign and do not require surgery. The main goal is to determine with MRI whether the tumour is benign or malignant and to assess its level of hormone secretion. Surgery may be required if hormone secretion is increased or the mass is larger than 10 mm.
Adrenal carcinomas are rare malignant tumours with a poor prognosis. About 60% are hormonally active and often cause Cushing’s syndrome. These tumours are usually 6 cm or larger. Treatment is complete surgical removal; besides surgery, the drug mitotane is also used.
Congenital adrenal hyperplasia
Congenital adrenal hyperplasia is a genetic disorder with two types. The classic type begins in the newborn period and is more severe: in girls it presents with impaired sexual development, while in boys it is detected at 5–10 years of age.
Symptoms of the late-onset type appear at puberty. In girls it causes excess hair growth and menstrual irregularities and closely resembles polycystic ovary syndrome. In boys it has no clinical signs and may be found during evaluation for infertility. Treatment is managed by an endocrinologist.
Primary adrenal insufficiency (Addison’s disease)
Addison’s disease develops when the adrenal glands do not function adequately. The main symptoms are:
- weakness, tiring easily
- loss of appetite, weight loss
- nausea, vomiting
- darkening of the skin
- dizziness
- muscle and joint pain
Adrenal crisis and treatment
Sometimes the symptoms of Addison’s disease worsen sharply, with fever, abdominal pain and loss of consciousness. This condition is called an “adrenal crisis”.
Treatment consists of taking the missing hormones as medication. It is important not to skip doses and to take them at set times and doses. Treatment is usually lifelong. Tell your doctor about any side effects, changes in the course of the disease or new complaints.
Other hormonal disorders
Hirsutism is the growth of coarse, dark hair in women in areas where hair is normally absent, and is a sign of excess androgens (male hormones). Increased androgens usually originate from the adrenal glands or ovaries; the most common cause is polycystic ovary syndrome.
Male hypogonadism is testosterone deficiency. See an endocrinologist in cases of delayed descent of the testes, delayed puberty, breast enlargement, erectile problems and reduced libido, orchitis, chemotherapy, or exposure to alcohol, chemicals or radiation. For diagnosis, total testosterone must be measured in the morning between 07:00 and 10:00.
Gynecomastia is breast enlargement in men. In newborns, adolescents and adults it can be physiological and resolve on its own within 6 months. The most important step is to distinguish it from breast cancer. Since many medications can cause gynecomastia, tell your doctor which ones you take. If it does not regress once the cause is treated, surgery or radiotherapy may be recommended.
Menopause is the end of menstrual periods, usually between the ages of 45 and 55. The most common symptoms are hot flushes, night sweats, sleep problems, vaginal dryness, poor concentration and forgetfulness. See your doctor if your cycle is shorter than 3 weeks, bleeding is heavy, or bleeding occurs after menopause.
Gender identity disorder: diagnosis and treatment involve joint assessment by a psychiatrist, an endocrinologist and a surgeon. Hormone therapy must be carried out only under an endocrinologist’s supervision, with check-ups every 3 months in the first year and then 1–2 times a year.
The information on this page is general and does not replace a medical examination.