screening for adrenal

Overview

The adrenal glands are two small, triangle-shaped glands that sit on top of your kidneys. They make hormones — natural chemical messengers — that help control blood pressure, blood sugar, how your body responds to stress, and the balance of salt and water in your body. Adrenal screening is a set of checks used to look for early signs of adrenal gland problems. It is not one single test — it depends on why screening is being done. Screening may be offered to newborns, to people taking certain long-term medicines, or to people with a family history of adrenal disorders.

Adrenal gland disorders are uncommon. Screening is not done for everyone — it is usually offered to people with a higher chance of having an adrenal problem, such as newborns, people on long-term steroid medication, or people with a family history of adrenal conditions.

Screening can be offered at any age. Newborns are screened for a specific inherited adrenal condition called congenital adrenal hyperplasia. Adults may be screened if they have certain health conditions, take long-term steroid medicines, or have an adrenal nodule found by chance on a scan. Both men and women can be affected.

Symptoms

Common symptoms

• Ongoing, unexplained tiredness or weakness
• Dizziness when standing up
• Weight gain or weight loss that is hard to explain
• High blood pressure that does not respond to usual care
• Muscle or joint aches
• Feeling stressed, anxious, or irritable
• Salt cravings
• Nausea, vomiting, or tummy pain
• Darkening of the skin, especially on scars, elbows, or palms — this can happen with certain adrenal conditions

Symptoms in children

• Slow growth or shorter height than expected
• Delayed puberty
• Weight gain, especially around the face and belly
• Early signs of puberty in girls, such as too much body hair
• Frequent illnesses or slow recovery from infections

Symptoms in older adults

• Increased tiredness or general weakness
• Falls or dizziness when standing up
• New or worsening high blood pressure
• Confusion or memory problems in some cases
• Poor appetite and unintentional weight loss
• Being less able to manage everyday tasks

Causes

Main causes

• Adrenal insufficiency (also called Addison's disease) — the adrenal glands make too little cortisol or aldosterone
• Congenital adrenal hyperplasia — an inherited condition that affects how the adrenal glands make hormones
• Cushing's syndrome — the adrenal glands make too much cortisol
• Pheochromocytoma — a rare tumour that makes extra adrenaline
• Adrenal nodules or tumours — growths found on scans that may or may not produce hormones

Risk factors

• Taking long-term steroid medicines (for example, for asthma, arthritis, or inflammatory bowel disease)
• Having an autoimmune condition, such as type 1 diabetes or thyroid disease
• A family history of adrenal or autoimmune conditions
• Having a child with congenital adrenal hyperplasia or a family history of it
• A scan that shows an unexpected growth on an adrenal gland
• Certain rare genetic syndromes

When to see a doctor

See a doctor urgently if:

• If you have symptoms of an adrenal crisis — such as seVere vomiting, fainting, or confusion — call your local emergency number immediately. Do not wait.
• If you take steroid medicines and suddenly stop them, or you are vomiting and cannot take your medicine, get medical help the same day.

Book a routine appointment if:

• Make an appointment if you have ongoing tiredness, dizziness, weight changes, or high blood pressure that worries you.
• If a newborn screening result or any other screening test comes back unusual, follow up with your healthcare provider as advised.
• If you have a long-term health condition and you have not discussed your adrenal risk with your doctor, bring it up at your next visit.

Diagnosis

Adrenal screening usually starts with a discussion about your health, then simple tests. Which tests you need depends on your age, symptoms, and medical history. The tests measure hormone levels in your blood, urine, or saliva, and sometimes involve scans to look at the adrenal glands. If a result is unusual, your doctor will arrange more tests — this is a normal next step, not a diagnosis.

Tests that may be done

• Blood tests — to measure cortisol, adrenocorticotropic hormone (ACTH), and other hormone levels
• Urine tests — to measure hormones passed out in pee, usually collected over 24 hours
• Saliva tests — often done late at night to check cortisol levels
• Stimulation or suppression tests — to see how well the adrenal glands respond to instructions from the brain
• Imaging scans (CT, MRI, or ultrasound) — to look at the size and shape of the adrenal glands
• Genetic tests — used in newborn screening and for families affected by congenital adrenal hyperplasia

What to expect at your appointment

Some blood tests need to be taken in the morning, when hormone levels are highest. A 24-hour urine test means collecting all your pee over a full day. A stimulation test involves a small needle and takes a few hours, with regular blood samples. Scans are painless and usually take less than an hour. Your care team will explain every step and answer your questions — you will not be left on your own.

Treatment

Treatment depends on the specific condition found. The goal is to replace missing hormones or to bring hormone levels back to a healthy range. Treatment is usually safe and effective, and most people with adrenal conditions manage them well with support from their healthcare team, which may include an endocrinologist — a doctor who specialises in hormones and metabolism.

Self-care at home

• Keep all scheduled appointments and have hormone levels checked as advised.
• Never stop or change a steroid medicine on your own — suddenly stopping can be very dangerous.
• Wear a medical alert bracelet or carry a steroid card if you have adrenal insufficiency.
• Learn to recognise the early signs of an adrenal crisis, and make sure your family and close friends know what to do.
• Ask your care team for a 'sick-day plan' to follow during illness.

Medical treatments

Treatment approaches include hormone replacement therapy, which replaces the hormones the adrenal glands are not making enough of. Other medicines may be used to reduce the amount of hormone the glands produce or to control blood pressure and symptoms. These medicines can be given as pills, injections, or patches, depending on the condition. Your doctor will work with you to choose the safest and most appropriate option for your situation.

When is surgery considered?

If a scan shows a large adrenal tumour or one that produces too much hormone, surgery to remove the affected gland may be recommended. This is a well-established operation, and most people recover well. Your surgeon will explain the benefits, risks, and what to expect so you can decide together.

Living with this condition

Living with an adrenal condition means building a routine that keeps your hormones balanced. This often involves taking prescribed medicines at the right times, attending regular check-ups, and telling any healthcare provider about your condition before procedures or treatments. With these habits, most people manage their day-to-day life with very few limits.

Lifestyle tips

• Try to keep a regular daily routine, including stable meal times and enough sleep.
• Find ways to manage stress, such as gentle walking, breathing exercises, or hobbies you enjoy.
• Carry your sick-day plan and a list of your medicines with you.
• Keep a medical alert ID or steroid card visible in your wallet, bag, or phone.
• Tell friends, family, or colleagues how to recognise warning signs and who to call in an emergency.

Diet and exercise

A balanced diet and gentle, regular activity support overall health. The right approach depends on your condition — for example, some people with adrenal problems need extra salt, while others need to limit it. Ask your dietitian or care team for personal guidance. Most people are encouraged to stay active, but check with your doctor before starting anything very intense.

Mental health and emotional wellbeing

Living with a hormone condition can feel overwhelming, and it is normal to feel worried, stressed, or low at times. You do not have to cope alone. Talk to your healthcare team, and let them know if your mood is affecting your daily life. Asking for help is a sign of strength, not weakness.

Prevention

Most adrenal conditions cannot be prevented, because they are caused by genes or by the body's own immune system. However, screening helps catch problems early — and early treatment can prevent many serious complications. An overall healthy lifestyle supports your body but does not stop adrenal disease from developing.

Screening programmes

Screening for adrenal conditions is most commonly offered to newborns: a small heel-prick blood spot test checks for congenital adrenal hyperplasia in many countries, including the UK. In adults, screening is used when symptoms or risk factors suggest a possible adrenal problem, or when a scan finds an adrenal nodule. Your doctor can tell you whether screening is recommended for you.

Complications

If left untreated

• Adrenal crisis — a life-threatening drop in cortisol that needs emergency treatment
• Dangerously high blood pressure that raises the risk of heart attack or stroke
• Bone thinning (osteoporosis) from too much cortisol
• Severe fatigue and a reduced quality of life
• Growth problems and delayed development in children if the condition is not controlled

Long-term outlook

The outlook for most adrenal conditions is excellent when they are found early. With the right treatment, regular monitoring, and good communication with your care team, most people lead full, active, and long lives. Everyone's journey is different, but there is real reason for hope — and you do not have to face it alone.

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