Adrenal gland diseases and disorders

Hyposecretion of cortisol from the adrenal gland causes Addison disease. Hypersecretion of cortisol causes Cushing syndrome. The following sections discuss these conditions.

Addison disease

Addison disease is a malfunction of the adrenal cortex, leading to adrenal insufficiency (hyposecretion) of cortisol. Addison disease affects adults ages 30 to 50, though it can occur at any age. Addison disease can be acute or chronic. Acute Addison disease may be called Addisonian crisis, a condition marked by life-threatening symptoms. A crisis can be brought on by stressful situations, infections, minor illnesses, or surgery.

The causes of Addison disease include an autoimmune reaction, tuberculosis, and damage to or disease of the adrenal glands or pituitary gland. Acute Addison disease can cause the following responses:

• Pain in the lower back, abdomen, and legs
• Severe vomiting and diarrhea, dehydration, and low blood pressure
• Loss of consciousness
• Hyperkalemia (an abnormally high blood potassium level) and hyponatremia

Chronic addison disease may occur over weeks to months. It can cause the following:

• Irritability, extreme fatigue, weight loss, lack of appetite, and a craving for salt
• Darkening of the skin and buccal membranes (hyperpigmentation)
• Hypotension, fainting, nausea, diarrhea, and vomiting
• Hypoglycemia
• Muscle pain, depression, and loss of body hair

After a physical exam, the provider may order blood tests (e.g., cortisol, sodium, potassium, and ACTH), imaging tests, and an ACTH stimulation test. The ACTH stimulation test measures the blood cortisol level before and after an injection of synthetic ACTH. If the adrenal gland is damaged, cortisol levels will still be low or absent after ACTH stimulation. Addisonian crisis treatment requires the immediate administration of an intravenous saline and dextrose solution with corticosteroids. Other treatments involve corticosteroids to replace cortisol and aldosterone and dietary changes (e.g., a diet high in carbohydrates and protein; adequate sodium and fluids).

Cushing disease

Cushing disease is a malfunction of the cortex of the adrenal gland, causing increased levels of cortisol. Cushing disease has the following causes:

• A benign pituitary tumor
• An adrenal adenoma (benign adrenal cortex tumor), a tumor that secretes ACTH
• Taking long-term corticosteroids for another medical condition (e.g., organ transplantation, severe asthma, or rheumatoid arthritis)

Cushing disease can cause the following:

• High blood pressure
• Weight gain, especially in the abdomen, upper back, face (moon face), and between the shoulder blades (buffalo hump)
• Pink or purple stretch marks on the abdomen, thighs, breasts, and arms
• Fragile, thin skin that bruises easily
• Infections, slow-healing wounds, and acne
• Severe fatigue, muscle weakness, and headaches
• Depression, anxiety, irritability, loss of emotional control, and difficulty thinking clearly
• Slowed or impaired growth in children
• Decreased libido and infertility in men
• Thicker or more noticeable facial and body hair (hirsutism or hypertrichosis) in women

After obtaining a medical history and performing a physical exam, the provider may order a number of tests:

• Blood, saliva, and urine tests to measure cortisol levels
• An ACTH stimulation test
• Imaging tests

Treatment is focused on the cause of the disorder and may include medications to control cortisol levels, radiation therapy to shrink the tumor, or surgery to remove the tumor.

Additional adrenal gland diseases and disorders

Additional adrenal gland diseases include these:

• Adrenocortical carcinoma: A malignant adrenal tumor that starts in the adrenal cortex.
• Congenital adrenal hyperplasia (CAH): A genetic disorder that causes the body to make a decreased amount of cortisol. Usually, people with CAH also have other hormone imbalances.
• Pheochromocytoma: A type of paraganglioma tumor that develops in the adrenal medulla and produces adrenaline, causing high blood levels of epinephrine.