Diseases of the adrenal glands

The main disorders

The adrenal glands have two parts: the cortex, which produces cortisol (the hormone of the stress response and metabolism), aldosterone (which regulates potassium, sodium and blood pressure) and androgens, and the medulla, which produces catecholamines (adrenaline and noradrenaline).

• Adrenal insufficiency: inadequate production of cortisol, sometimes also of aldosterone.
• Cushing’s syndrome: prolonged exposure to excess cortisol, often from corticosteroid medicines, or from tumors of the pituitary or adrenals.
• Primary hyperaldosteronism: excess aldosterone, linked to hypertension and sometimes low potassium.
• Pheochromocytoma: a rare tumor that may produce catecholamines and cause episodes of hypertension.
• Incidentally discovered masses (incidentaloma): these require assessment of their features and hormone production.

Which signs call for assessment

Lack of cortisol may come with fatigue, weakness, loss of appetite, weight loss, abdominal pain and dizziness; in primary insufficiency, darkening of the skin may also appear. Excess cortisol can cause weight gain with a rounded face and fat on the neck and back, muscle weakness, easy bruising and wide purple stretch marks. Hypertension that is hard to control, low potassium or episodes with headache, sweating and palpitations may call for hormonal investigation. These symptoms also have other, often more common, causes.

How they are diagnosed

Tests are chosen according to suspicion: cortisol and ACTH, special tests for cortisol excess (late-night salivary cortisol, the dexamethasone suppression test), aldosterone and renin, or metanephrines in plasma or urine. The time of sampling, medicines and testing conditions affect the result; a cortisol measured at random does not by itself diagnose every disorder. To clarify masses, CT or magnetic resonance imaging may be recommended at a suitable center. A mass does not automatically mean cancer; most incidentalomas are benign adenomas.

How they are treated

Treatment may include hormone replacement (hydrocortisone and, when needed, fludrocortisone), drugs that control hormone excess, or surgery. The choice is tailored to the diagnosis. People with adrenal insufficiency need a written plan for acute illness (doubling or tripling of the dose during fever, and an injection when oral medicines cannot be kept down) and a warning card. Do not stop long-term corticosteroids abruptly, because this can cause an adrenal crisis, and do not change the regimen without instruction. Checks take place every 6 months to a year, or sooner when the doctor considers it reasonable.

Care at Tirana Polyclinic: we offer endocrinology consultation, interpretation of tests and external imaging, and guidance on specialized work-up and treatment.