ADRENAL DISEASE

What is Adrenal Disease?

Adrenal disease is a disorder of the adrenal gland that results in a lump on the adrenal gland or abnormal production of a patient’s hormone.

Hormone Levels production can be either:

  • Too much of a hormone or

  • Too little of a hormone

An example of an adrenal disease is when the cortisol hormone production from the adrenal gland is abnormal and either:

  • Too much cortisol (Cushing's Disease) or

  • Not enough cortisol (Addison's Disease)

What is the Anatomy of Adrenal Gland

The adrenal glands are two small glands located on top of each kidney. They are located towards the back of the abdomen.

The adrenal glands produce important hormones to keep you healthy. These  include:

  • Adrenaline - Regulates the "fight-or-flight" response and maintains metabolic processes, such as managing blood sugar levels and blood pressure.

  • Aldosterone - Regulates the balance of salt and water and blood pressure

  • Cortisol - Helps control the stress response and other functions.

  • Sex Hormones - Important for initiating puberty and sexual maturation during adolescence and maintaining sexual characteristics as an adult.

What are the Types of  Adrenal Disease?

There are many forms of adrenal disease. Some are:

  • Cushing's disease- Overproduction of the hormone cortisol

  • Primary hyperaldosteronism - Overproduction of the hormone aldosterone causing high blood pressure and abnormal levels of body salt and potassium

  • Pheochromocytoma- Overproduction of hormones like adrenaline

  • Adrenal insufficiency (Addison's Disease) - Under-production of cortisol

  • Adrenal crisis

  • Congenital Adrenal Hyperplasia (CAH)

  • Adrenal Adenoma- a type of benign lump on the adrenal gland that can make excess amounts of the hormone

  • Adrenocortical Carcinoma (Cancer)

Adrenal Tumours

Adrenal gland tumours involve abnormal growths on the adrenal glands— most are benign (not cancerous), but some can be malignant (cancerous).

Sometimes even if the adrenal lump is benign it can still produce lots of extra hormones that can make you unwell.

What are the Causes of Adrenal Disease

Causes of adrenal gland disorders include

  • Genetic mutations

  • Autoimmune conditions (where the immune system attacks the body)

  • Haemorrhage (Bleeding)

  • Cancer in the adrenal gland

  • Benign tumours that make extra hormones such as pheochromocytomas

  • Infections of the adrenal gland

  • A problem in another gland, the pituitary, which helps to control the adrenal gland

  • Certain medications

What are the Types of Adrenal Insufficiency

  • Primary adrenal insufficiency is where the adrenal gland does not work because it is diseased.  The pituitary is working normally in this condition.

  • Secondary adrenal insufficiency is where the adrenal gland does not work because the pituitary is not working

Who is at risk of Adrenal Gland Tumours

  • People with certain hereditary conditions have a higher risk of developing an adrenal gland tumour

  • People on blood thinners or with bleeding problems can uncommonly develop bleeding problems in the adrenal gland

  • People with infections like tuberculosis can get infections in the adrenal gland

What are the Symptoms of Adrenal Disease?

Symptoms of Adrenal Disorders vary depending on the type of disease.

If hormones are too high common symptoms are:

  • Fatigue

  • High blood pressure

  • Increasing weight or round face and neck

  • Thin skin or easy bruising

  • Muscle and bone weakness

  • High blood sugars

  • Skin problems, such as acne or reddish-blue streaks on the abdomen or underarm area

  • Extra hair growth

  • Changes in mood, anxiety or depression

  • Change in the menstrual period in women

  • Palpitations or heavy beating of the heart

  • Headaches

If hormones are too low common symptoms are:

  • Low blood pressure or dizziness

  • Feeling tired or fatigued

  • Moodiness, irritability, or depression

  • Weight loss

  • Slow growth rates in children

  • Change in the menstrual period in women

  • Nausea (Feeling like want to vomit)

Diagnostic test for Adrenal Disease

Typically a pathology test and/or scan is required for an accurate diagnosis.

The type of suspected disorder may determine which pathology test is required. Some tests may require fasting or multiple tests at certain times of the day.  Usually, hormone blood tests are best collected first thing in the morning. Usually, saliva tests are best collected late at night at around midnight.

Samples collected could include:

  • Blood

  • Urine

  • Saliva

Sometimes scans are needed such as :

  • CT scan, MRI scan or ultrasound of the adrenal gland to look for lumps or tumours

  • Nuclear medicine scan to look at how the adrenal gland works

Sometimes scans are done to check if hormone problems have caused damage to other parts of the body

  • Bone density to look for osteoporosis (Weak bones)

  • Cardiac echo (special heart ultrasound)

How can Adrenal Disease be managed?

Treatment depends on which problem you have. Options to treat adrenal gland problems include:

  • Surgery

  • Medicine

  • Nuclear medicine like MIBG for pheochromocytoma

  • Careful observation with your endocrinologist

Medication for Adrenal Disease

Medications are available for some forms of Adrenal Disease. They can be used to either

  • Stop the excess production of hormones or

  • Act as hormone replacement for low hormone production

Preparation for Adrenal Surgery includes

  • Specific blood work

  • Additional x-rays or imaging

  • Consultation with other specialists may be required depending on your medical problems

  • Specific medications before, during and/or after your surgery.

Adrenal Surgery (Adrenalectomy)

An Adrenalectomy involves the removal of the adrenal gland. The surgery is performed under general anaesthesia and most often require at least an overnight stay in the hospital.

The surgical approach is determined by:

  • Tumour size

  • Patient characteristics (body size, shape, medical conditions, previous operations, etc)

  • The surgeon’s preferences of which will achieve the best outcome for you

Types of Adrenalectomy

An Adrenalectomy can be performed either as an open and laparoscopic procedure.

  • Open Adrenalectomy uses a large incision (usually beneath the rib-cage). This approach is preferred for very large tumours and for tumors with a high risk of cancer.

  • Laparoscopic Adrenalectomy (minimally invasive or keyhole surgery) approach uses multiple small incisions and a camera to remove the adrenal gland.

Benefits of a Minimally Invasive Approach

The laparoscopic technique allows for

  • Shorter hospital stays

  • Decreased blood loss

  • Less post-operative pain

  • Quicker recovery and

This has become the standard approach for adrenalectomy in most patients.