questions to ask before adrenal

Overview

The adrenal glands are two small glands that sit on top of your kidneys. They make hormones that help control blood pressure, blood sugar, stress responses, and salt and water balance. Sometimes these glands become overactive, develop a growth, or stop working properly. Your doctor may suggest surgery to remove one or both adrenal glands. Asking questions before surgery helps you understand the risks, benefits, and what life will be like afterward.

Adrenal nodules are found in about 1 in 20 to 1 in 30 people, but they are rarely harmful. Surgery to remove an adrenal gland is much less common and is done only when there is a clear medical reason.

Adrenal conditions can affect people of any age, including children. Some types of adrenal tumors are more common in women, while others are more common in men. The need for surgery depends on the specific condition and the person's overall health.

Symptoms

Common symptoms

• High blood pressure that is hard to control
• Weight gain, especially around the face and belly
• Muscle weakness and fatigue
• Anxiety or mood changes
• Headaches and sweating (sometimes from certain adrenal tumors)
• Bruising easily and slow healing

Symptoms in children

• Slow growth or short height
• Early or delayed puberty
• Weight gain with a round face
• High blood pressure
• Behavior changes or trouble at school

Symptoms in older adults

• Fatigue and weakness that come on gradually
• Loss of appetite and weight loss
• Confusion or memory problems
• High blood pressure or abnormal blood pressure readings
• Falls related to dizziness or muscle wasting

Causes

Main causes

• Benign (non-cancerous) adrenal adenomas — common and usually harmless
• Overactive adrenal glands (producing too much cortisol, aldosterone, or adrenaline)
• Cancer of the adrenal gland (adrenocortical carcinoma) — rare
• Pheochromocytoma — a tumor that makes extra adrenaline and can cause dangerous blood pressure swings

Risk factors

• A family history of certain adrenal conditions
• Genetic syndromes (like multiple endocrine neoplasia) — these are rare
• High blood pressure or diabetes that is hard to control
• Age and sex — some adrenal tumors are more common in women or older adults

When to see a doctor

See a doctor urgently if:

• If you faint, can't keep food down, or become confused, call your local emergency number right away.
• If you have chest pain, severe headache, or trouble breathing, seek urgent care.
• If you have known adrenal disease and develop vomiting or diarrhea, get medical help the same day.

Book a routine appointment if:

• If you have persistent weakness, weight changes, or high blood pressure, make an appointment with your GP.
• If you were found to have an adrenal nodule by chance, ask your doctor if you need any follow-up tests.
• See your doctor before any planned surgery to discuss your adrenal condition and medication plans.

Diagnosis

Your doctor will ask about your symptoms, examine you, and order blood tests, urine tests, and sometimes a scan of your abdomen. These tests show whether your adrenal glands are making too much or too little hormone, and whether there is a growth that needs attention.

Tests that may be done

• Blood tests for hormone levels, including cortisol and aldosterone
• Urine tests to measure hormone breakdown products
• Imaging tests like CT (computed tomography) or MRI (magnetic resonance imaging)
• Sometimes a fine-needle biopsy, if cancer is suspected — though this is not done for all tumors

What to expect at your appointment

You may need to fast (not eat or drink) before a blood test. Some tests require you to collect urine over 24 hours. The scan itself is painless. Your doctor will explain each step and will ask you to stop certain medicines if that is needed — never stop any medicine without your doctor's advice.

Treatment

Treatment depends on the cause. If the adrenal gland is overactive or has a large or suspicious growth, surgery to remove it may be recommended. In some cases, medicines can help control hormone levels, but surgery is the only way to remove some tumors. If both adrenal glands are removed, you will need daily hormone replacement pills or patches for life.

Self-care at home

• Keep a symptoms diary to share with your surgeon or endocrinologist.
• Make a list of all current medicines and supplements to show your care team.
• Ask how long you should not eat before the surgery and when you can return to normal activities.
• Arrange for someone to drive you home from hospital and help you for the first days.

Medical treatments

For some adrenal conditions, medications may be used to block the effects of too much hormone, control blood pressure, or replace missing hormones. Your endocrinologist (a doctor who specialises in hormones) will decide the safest plan for your situation. Any medicine you take must be prescribed and adjusted by your healthcare team.

When is surgery considered?

Surgery is usually considered when an adrenal tumor is large, is growing, or makes too much hormone. The operation is often laparoscopic (keyhole surgery), which means smaller cuts and a quicker recovery. In some cases, a larger open surgery is needed. Ask your surgeon which technique they recommend and why.

Living with this condition

After adrenal surgery, you will need some time to rest — usually two to six weeks depending on the type of surgery. You will have regular follow-up appointments to check your hormone levels. If you lose one adrenal gland, your remaining gland usually takes over after a few weeks. If both are removed, you will need hormone replacement every day. Always wear a medical ID bracelet or carry a card that says what steroids you take, and keep an emergency supply in case you are ill.

Lifestyle tips

• Take your replacement hormones exactly as prescribed — never skip a dose.
• Learn the signs of adrenal crisis and tell your family and friends what to do in an emergency.
• Wear a medical alert bracelet or carry an alert card.
• Tell every doctor, dentist, or nurse that you have adrenal disease before any procedure.

Diet and exercise

A balanced diet is important for managing blood pressure and weight. Eating plenty of fruits, vegetables and whole grains, and cutting down on salt can help. Exercise is safe for most people after recovery — start gently and build up your activity. Ask your care team about your specific limits before you begin.

Mental health and emotional wellbeing

Living with an adrenal condition can be stressful. Hormone changes can affect your mood, energy, and ability to cope. It is normal to feel anxious, fearful, or sad at times. Please be gentle with yourself, talk to your loved ones, and ask for support from a counsellor or mental health professional if you need it. You are not alone.

Prevention

Most adrenal conditions cannot be prevented, because they are caused by changes in your genes or by chance. However, you can reduce the risk of complications by keeping regular appointments, monitoring your blood pressure, and following your doctor's advice.

Vaccines

Vaccines are not used to prevent adrenal conditions. But if you take steroid replacement, it is especially important to have recommended vaccines like flu and COVID-19 jabs, because you may be more vulnerable to infection. Talk to your health team.

Screening programmes

If you have a family history of certain adrenal tumors, your doctor may suggest regular blood or imaging tests. Screening is not recommended for everyone — it depends on your personal risk.

Complications

If left untreated

• If an overactive adrenal gland is not treated, high blood pressure can damage the heart, kidneys, and eyes.
• High cortisol levels can cause weight gain, diabetes, bone thinning, and increased risk of infections.
• A large adrenal tumor could occasionally turn out to be cancer and might spread if left undetected.
• If both adrenal glands are removed and hormone replacement is not taken, a life-threatening adrenal crisis can happen.

Long-term outlook

The outlook for most adrenal conditions is good. Many growths are harmless and need no treatment. When surgery is needed, it is successful in most cases, and people usually return to their normal activities after recovery. With careful follow-up and, if needed, hormone replacement, you can live a healthy and full life.

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