adrenal overview for patients

Overview

Your adrenal glands are two small triangular organs that sit on top of your kidneys. They make hormones that help your body respond to stress, control blood pressure, balance salt and water, and support healthy metabolism. This overview explains what your adrenal glands do and what can happen when they make too much or too little of these hormones.

Adrenal gland disorders are not common, but they can be serious. One of the best-known conditions, Addison's disease, affects about 1 in 10,000 people. Other adrenal problems are even rarer.

Adrenal disorders can affect people of all ages, including newborns, children, and older adults. Some types are more common in women, while others affect men and women equally.

Symptoms

Common symptoms

• Fatigue that doesn't improve with rest
• Unintentional weight loss or weight gain
• Muscle weakness
• Low blood pressure (feeling dizzy when standing up)
• Nausea, vomiting or diarrhea
• Skin darkening (with some types of adrenal insufficiency)

Symptoms in children

• Poor growth or slow weight gain
• Delayed puberty
• Unexplained fever or stomach pain
• Low blood sugar (irritability, shakiness)

Symptoms in older adults

• Confusion or changes in thinking
• Falls due to dizziness or low blood pressure
• Dehydration
• Longer recovery from illness or injury

Causes

Main causes

• Autoimmune destruction of the adrenal glands (the body attacks its own tissue)
• Infections that damage the adrenal glands, including tuberculosis
• Tumors or growths on the adrenal glands that make too much hormone
• Damage to the pituitary gland, which controls the adrenal glands
• Certain medicines, such as long-term steroid use, that can suppress adrenal function

Risk factors

• Having an autoimmune disease (such as type 1 diabetes or thyroid problems)
• Taking long-term oral or inhaled steroids
• Family history of adrenal disorders
• History of pituitary surgery or head injury
• Certain infections such as tuberculosis

When to see a doctor

See a doctor urgently if:

• If you have symptoms like fainting, severe vomiting, or confusion, seek care immediately
• If you are being treated for adrenal insufficiency and are sick or injured, contact your healthcare team or go to urgent care

Book a routine appointment if:

• If you have persistent fatigue, weight changes, or dizziness that is not explained
• If you have new skin darkening or unusual pigmentation
• If you have a family history of adrenal disease and are concerned about your risk

Diagnosis

Diagnosis starts with a detailed medical history and physical exam. If your doctor suspects an adrenal problem, they will order blood and urine tests to measure hormone levels. Depending on the results, you may be referred to an endocrinologist, a doctor who specializes in hormones and metabolism.

Tests that may be done

• Blood tests for cortisol, aldosterone, adrenocorticotropic hormone (ACTH), and electrolytes
• ACTH stimulation test (measures how your adrenal glands respond to a hormone that tells them to make cortisol)
• Urine test to measure cortisol over 24 hours
• Imaging scans such as CT or MRI of the adrenal glands or pituitary gland
• Blood pressure and blood sugar checks

What to expect at your appointment

Testing may take several visits. You may be asked to fast, stop certain medications, or avoid stress before some tests. Results usually come back within days to weeks. If you are in adrenal crisis during testing, you will be treated immediately before all tests are completed.

Treatment

Treatment depends on the specific adrenal disorder and whether your glands are underactive or overactive. The main goals are to bring hormone levels back to normal, manage symptoms, and prevent emergencies.

Self-care at home

• Wear a medical alert bracelet so emergency workers know about your adrenal condition
• Learn to adjust your medication during illness or stress (only with your doctor's instructions)
• Carry emergency supplies, including a steroid injection kit if prescribed
• Stay hydrated and avoid skipping meals if you have low blood sugar risk
• Keep regular follow-up appointments with your healthcare provider

Medical treatments

For underactive adrenal glands, treatment is life-long hormone replacement therapy. You take pills or sometimes injections to replace missing hormones. The dose may need to be increased during illness, injury, or surgery — this is called a 'stress dose'. For overactive adrenal glands, treatment may include medicines to block excess hormone production, and in some cases, surgery to remove the tumor or affected gland. Always follow your provider's prescription exactly; never stop or change your medication on your own.

When is surgery considered?

Surgery may be needed if a noncancerous tumor is causing hormone excess, or if the adrenal gland itself is damaged. In some cases, both adrenal glands are removed, and you will then need lifelong hormone replacement.

Living with this condition

With proper treatment, most people with adrenal disorders lead active, full lives. It requires daily medication and attention to sick days, but once the right plan is in place, symptoms usually improve.

Lifestyle tips

• Take your medicines at the same times each day as prescribed
• Plan ahead for travel, illness, and changes in schedule
• Teach family members how to recognize symptoms of an adrenal crisis
• Wear medical identification at all times
• Attend scheduled follow-up appointments

Diet and exercise

A balanced diet with enough salt can help, especially for those with aldosterone deficiency. Regular exercise supports your heart, bones, and mood. Talk to your care team about how much salt and fluid you need, and let your exercise plan match your energy levels.

Mental health and emotional wellbeing

Living with a chronic adrenal condition can sometimes feel draining. You may worry about having an adrenal crisis or dealing with symptoms for a long time. It is normal to feel anxious or frustrated. Talking with friends, family, or a counsellor can help. If you ever feel overwhelmed, reach out to your healthcare team for support.

Prevention

Most adrenal disorders cannot be prevented because they are caused by autoimmune reactions, genetics, or tumors. However, you can reduce the risk of an adrenal crisis by managing stress, avoiding infections, and working closely with your healthcare team to adjust your medication when you are sick.

Vaccines

Keep your vaccinations up to date, including the flu and pneumonia vaccines, as infections can trigger adrenal crisis. Ask your healthcare provider which vaccines are right for you.

Screening programmes

Routine screening for adrenal disorders is not recommended for the general public. If you have a family member with an adrenal condition, your doctor may suggest testing if you develop symptoms.

Complications

If left untreated

• Adrenal crisis (a life-threatening drop in blood pressure and blood sugar)
• Severe dehydration and electrolyte imbalance
• Osteoporosis (weak bones) with prolonged excess cortisol
• High blood pressure and diabetes with prolonged overproduction of cortisol or aldosterone
• Growth and development problems in children

Long-term outlook

With early diagnosis and careful treatment, the outlook for most adrenal disorders is very good. People can expect to feel better once hormone levels are balanced. It takes time and adjustment, but many patients manage their condition successfully and enjoy long, active lives.

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