adrenal in older adults

Overview

The adrenal glands are two small hormone-producing organs that sit on top of each kidney. They make hormones that help control blood pressure, blood sugar, the body’s stress response, and the balance of salt and water. As you age, these glands may work a little differently, but they usually continue to function well. Sometimes, though, adrenal problems can develop, especially in older adults who have other medical conditions or take certain medicines.

Adrenal diseases are uncommon overall. However, the risk can increase with age, especially for people with chronic illnesses, infections, or those who have had surgery. Many people worry about 'adrenal fatigue,' but this is not a recognized medical condition. Talk to your doctor if you have ongoing symptoms.

Adrenal problems can affect anyone, but older adults over 65 are more vulnerable, particularly those with diabetes, high blood pressure, autoimmune conditions, or a history of long-term steroid treatment. It can also affect people who have experienced a major physical stress, such as an infection or surgery.

Symptoms

Common symptoms

• Feeling very tired or weak
• Dizziness or lightheadedness when standing up
• Low blood pressure
• Unintentional weight loss
• Nausea or poor appetite
• Craving salty foods

Symptoms in children

• Poor weight gain or failure to thrive
• Frequent vomiting or dehydration
• Low blood sugar (shakiness, sweating, irritability)
• Unusual tiredness or darkening of the skin

Symptoms in older adults

• Confusion or memory problems that come and go
• Falls or unsteadiness
• Loss of appetite leading to weight loss
• Symptoms that look like depression or low mood
• Muscle aches or joint pain with no clear cause

Causes

Main causes

• Autoimmune disease — the body’s immune system mistakenly attacks the adrenal glands.
• Infections that affect the adrenal glands, such as tuberculosis or certain fungal infections.
• Long-term use of steroid medicines, which can suppress the adrenal glands' own production.
• Problems with the pituitary gland in the brain, which controls the adrenal glands.

Risk factors

• Age over 65
• Chronic medical conditions like diabetes or lung disease
• Recent major surgery, injury, or severe infection
• Taking strong pain or anti-inflammatory steroid medicines for a long time

When to see a doctor

See a doctor urgently if:

• If you faint or nearly faint
• If you have repeated vomiting and cannot keep down fluids
• If you feel confused or very weak without a clear reason

Book a routine appointment if:

• If you have been feeling unusually tired, dizzy, or losing weight for several weeks
• If you have a strong craving for salt
• If you have been on steroid medicines and are concerned about adrenal function

Diagnosis

Your doctor will start by asking about your symptoms, medical history, and any medicines you take. They will check your blood pressure lying down and standing. If adrenal problems are suspected, they will order blood and urine tests to check hormone levels and salt concentrations in your body.

Tests that may be done

• Blood test for cortisol and a hormone called ACTH
• Blood test for sodium, potassium, and glucose
• Urine test to see how much cortisol your body is making
• A stimulation test, where you are given a small amount of a synthetic hormone to see if your adrenal glands respond normally

What to expect at your appointment

Adrenal testing may take several hours at a hospital or outpatient clinic. You might be told not to eat or drink for a few hours before some tests. The healthcare team will explain everything step by step. If you are taking steroid medicines, they will tell you exactly how to prepare — never stop any medicine on your own.

Treatment

Treatment depends on the cause and severity of the adrenal problem. The goal is to replace hormones your body is missing, help you feel better, and prevent dangerous drops in blood pressure or blood sugar. You will work closely with an endocrinologist, a doctor who specialises in hormones.

Self-care at home

• Take all prescribed medicines exactly as directed, even when you feel well.
• Learn 'sick day rules' from your doctor for what to do during illness or stress — you may need extra medicine or fluids.
• Wear a medical alert necklace or bracelet that tells emergency staff about your adrenal condition.
• Carry a little emergency supply of medicine and instructions when you travel.

Medical treatments

Medical treatment usually involves taking replacement hormones to make up for what your adrenal glands no longer produce. This may include a daily pill to replace cortisol and, in some cases, another pill to help control sodium and blood pressure. Some people need injections of hormones during severe illness or injury. The doses are tailored to each person and adjusted over time. If your adrenal problem is caused by a steroid medicine you take, your doctor will guide you through a slow, careful reduction — never stop suddenly.

When is surgery considered?

Surgery is rarely needed for adrenal problems in older adults. It might be considered if a tumour on the adrenal gland is causing excessive hormone production or if the gland is severely damaged, but this is uncommon and always discussed thoroughly with your care team.

Living with this condition

Living with an adrenal condition means paying a little more attention to your body’s signals. Keep regular contact with your healthcare team, review your emergency plan, and make sure a family member or caregiver knows what to do if you become ill or injured.

Lifestyle tips

• Avoid skipping meals — eat regularly to keep blood sugar stable.
• Stay well hydrated, and ask your doctor if you need extra salt in your diet.
• Manage stress with gentle activities like walking, breathing exercises, or talking to friends.
• Don't stop or change your adrenal medicines without medical advice.

Diet and exercise

Eat a balanced diet with enough protein, healthy fats, and carbohydrates. Some people need more salt, especially in hot weather or after exercise, but check with your doctor first. Gentle, regular exercise — such as walking or swimming — helps maintain muscle strength and balance, but avoid overdoing it. If you feel dizzy, sit down and rest.

Mental health and emotional wellbeing

Living with a hormone condition can affect your mood, especially if you feel tired or worried. It’s normal to feel frustrated or anxious. Speak honestly with your doctor about your emotional health, and ask about counselling or support groups if you need them. If you are in immediate distress, contact your local mental health crisis service or emergency number.

Prevention

Most adrenal conditions cannot be fully prevented, but you can reduce your risk by using steroid medicines safely and only when needed. Regular check-ups for chronic conditions like diabetes and high blood pressure also help maintain overall health.

Vaccines

Stay up to date with recommended vaccines, especially flu, pneumonia, and COVID-19. Infections can put extra stress on your body and may worsen an adrenal condition. Talk to your doctor or pharmacist about which vaccines are right for you.

Screening programmes

Routine screening for adrenal problems is not recommended for everyone. However, if you take long-term steroid medicines or have a condition that affects the pituitary gland, your doctor will monitor your adrenal function regularly.

Complications

If left untreated

• Adrenal crisis — a life-threatening drop in blood pressure and salt levels that requires emergency care.
• Persistent low blood pressure, leading to falls or fainting.
• Kidney problems due to dehydration and salt imbalance.
• Severe fatigue that makes it difficult to perform daily activities.

Long-term outlook

With proper diagnosis and treatment, most older adults with adrenal conditions can lead active, full lives. Treatment is usually straightforward and very effective. The key is to work closely with your healthcare team, follow your treatment plan, and know what to do when you are sick. Being prepared and informed gives you the best chance of staying well.

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