Diseases of the adrenal glands

Adrenal tumours can lead to serious secondary diseases such as high blood pressure, osteoporosis and diabetes. They are often discovered as an incidental finding during the diagnosis of specific conditions in other organs. Diagnosis is made using modern imaging techniques such as sonography, computed tomography (CT) and magnetic resonance imaging (MRI).

These changes are called incidentalomas. If they are small and do not produce hormones, they are only observed as they progress. Hormone production should be ruled out at least once. The adrenal glands produce the following hormones: cortisol, aldosterone, epinephrine and norepinephrine, and a precursor of male hormones called androgens.

If an adrenal tumour also produces one of these hormones, this can lead to specific clinical pictures:

• Conn's syndrome (overproduction of aldosterone) with increased blood pressure and low potassium levels
• Cushing's syndrome (overproduction of cortisol) with weight gain, osteoporosis and diabetes
• Pheochromocytoma (overproduction of adrenaline and/or noradrenaline) with increased blood pressure
• Masculinisation symptoms in women (overproduction of androgens) e.g. beard growth

If the hormone production is increased, the adrenal tumour is very large, the imaging findings indicate that the tumour is malignant, or the tumour is growing significantly, surgery is required. Depending on the hormone produced, special preparation and follow-up treatment may be needed.

In adrenal insufficiency, the adrenal glands produce too little or no hormones. It is particularly critical when the hormone cortisol can no longer be produced. This is because cortisol plays a vital role in many processes in the human body.

Causes

There are many causes of adrenal insufficiency. The adrenal glands are often destroyed as part of an autoimmune reaction. One adrenal gland can usually still produce enough hormones. However, if both adrenal glands have to be surgically removed, those affected are dependent on hormone therapy with cortisol.

Hormone therapy with cortisol and aldosterone

In addition to cortisol, the hormone aldosterone, which helps regulate blood pressure, is also replaced. Cortisol also plays a part in this function. It is therefore not so dangerous if aldosterone is not replaced temporarily. However, cortisol therapy for adrenal insufficiency must never be stopped. Adrenaline and noradrenaline are produced by the nervous system as well as the adrenal glands, so no replacement is needed.