Adrenal disorders involve the suprarenal glands, two small but powerful endocrine glands that sit on top of each kidney. These glands produce key hormones, such as cortisol and aldosterone, to help regulate the body’s metabolism, blood pressure, immune function and stress response.
Many adrenal disorders begin when the delicate communication system known as the hypothalamic-pituitary-adrenal (HPA) axis becomes disrupted. Normally, the hypothalamus in the brain signals the pituitary gland to release adrenocorticotropic hormone (ACTH), which then stimulates the adrenal glands to produce cortisol. Aldosterone production is regulated primarily by the renin-angiotensin-aldosterone system and blood potassium levels. When any part of this feedback loop malfunctions—whether in the brain or within the adrenal glands themselves—hormone levels can rise too high or fall too low.
Over time, a hormonal imbalance can affect nearly every organ system in the body. Excess cortisol may increase blood sugar, weaken bones and redistribute body fat. Insufficient cortisol can lead to severe fatigue, low blood pressure and life-threatening complications, such as adrenal crisis. Too much aldosterone can cause high blood pressure and dangerously low potassium levels. Too little aldosterone may result in dehydration, low blood pressure and electrolyte imbalances.
Adrenal disorders are relatively uncommon but clinically significant. In the United States, Addison’s disease affects roughly 1 in 100,000 people, and only a small number of new cases are diagnosed each year. Cushing’s syndrome is also rare, with an estimated 10 to 15 new cases diagnosed annually per million people. Some adrenal conditions, including autoimmune Addison’s disease and Cushing’s syndrome, are more common in women, while others, such as pheochromocytoma, affect men and women at similar rates.
While adrenal disorders can be complex, they are often highly manageable with an early diagnosis and specialized care. Importantly, most adrenal tumors are benign, although they can still disrupt hormone production.
What Are the Types of Adrenal Disorders?
Adrenal disorders are classified based on whether a growth (mass) is present and whether the glands produce too much or too little hormones. Each condition requires a tailored diagnostic and treatment approach.
Addison’s Disease
Also known as primary adrenal insufficiency, Addison’s disease occurs when the adrenal glands do not produce enough cortisol and, in many cases, aldosterone. Most commonly, this adrenal disorder is caused by an autoimmune response that damages adrenal tissue. Without treatment, it can lead to adrenal crisis, a medical emergency.
Adrenal Cancer
Adrenal cancer, or adrenocortical carcinoma, is rare. Unlike benign adrenal adenomas, cancerous tumors may grow rapidly and spread to other organs and tissues. An adrenal tumor may be functional—which means it produces excess hormones—or nonfunctional. Early detection and specialized surgical care are critical to achieve the best possible outcome and quality of life.
Congenital Adrenal Hyperplasia (CAH)
CAH is a group of inherited adrenal disorders that affect the enzymes needed for cortisol production. The resulting hormone imbalance begins at birth and may alter growth, development and reproductive health.
Conn’s Syndrome
Also known as primary hyperaldosteronism, Conn’s syndrome occurs when the adrenal glands produce too much aldosterone. This can lead to high blood pressure and low potassium levels. In many cases, the condition is caused by a benign adrenal adenoma.
Cushing’s Syndrome
Cushing’s syndrome results from prolonged exposure to excess cortisol. It may be caused by an adrenal tumor, a pituitary tumor (Cushing’s disease) or long-term corticosteroid use. The condition can affect metabolism, immune function and body composition.
Pheochromocytoma
A pheochromocytoma is a rare tumor of the adrenal medulla that produces excess catecholamines, such as adrenaline. This can cause sudden spikes in blood pressure, headaches and heart palpitations. Most pheochromocytomas are benign.
What Are the Causes and Risk Factors for Adrenal Disorders?
Adrenal disorders have been linked to a variety of autoimmune processes, inherited genetic mutations and environmental influences. Common causes and risk factors include:
- Autoimmune response – The immune system can sometimes mistakenly attack healthy adrenal tissue, which can reduce hormone production, as seen in many cases of Addison’s disease.
- Genetic predisposition – An inherited gene mutation can disrupt the enzymes involved in hormone synthesis, which occurs with congenital adrenal hyperplasia or certain familial tumor syndromes.
- Existing health conditions – Certain autoimmune diseases, such as Type 1 diabetes and thyroid disorders, may increase the risk of adrenal disorders, and chronic uncontrolled hypertension may signal underlying aldosterone excess.
- Prior treatments – Long-term corticosteroid therapy can suppress the HPA axis, while radiation therapy and certain medications may impair adrenal or pituitary function.
In some cases, the cause of an adrenal disorder is primary, which means the problem originated in the adrenal gland itself. In others, the issue is secondary, which means it was caused by abnormal signaling from the pituitary gland or hypothalamus. Identifying whether the cause is primary or secondary is essential, as it directly guides treatment.
What Are the Signs and Symptoms of Adrenal Disorders?
Adrenal disorder symptoms often develop gradually and may resemble other conditions, which is common in endocrinology. Because adrenal hormones influence multiple organ systems, imbalances can affect metabolism, cardiovascular function, immune response and mood.
Possible warning signs of an adrenal disorder include:
- Fluctuations in blood pressure
- Increased or decreased heart rate
- Mood changes, such as irritability or depression
- Muscle weakness
- Persistent fatigue
- Skin changes, including hyperpigmentation
- Temperature sensitivity
- Unexplained weight gain or loss
What Do Adrenal Disorders Feel Like?
Many patients with an adrenal disorder describe a profound sense of exhaustion that does not improve with rest. Low cortisol levels may cause nausea, mental fog or dizziness upon standing, while excess cortisol can lead to restlessness, anxiety and difficulty sleeping. Hormonal shifts can also affect emotional well-being, which may contribute to irritability, depression or panic attacks.
What Do Adrenal Disorders Look Like?
Visible signs of an adrenal disorder can vary based on the underlying condition. In Cushing’s syndrome, elevated cortisol can cause thinning of the skin, purple stretch marks, a rounded “moon face” and fat accumulation between the shoulders, which is often described as a “buffalo hump.” Addison’s disease may cause darkening of the skin, especially in scars and creases. Unexplained weight fluctuations and facial fullness are often outward indicators of a hormonal imbalance caused by an adrenal disorder.
How Are Adrenal Disorders Diagnosed?
Diagnosing an adrenal disorder generally requires a precise laboratory evaluation and careful interpretation. Because hormone levels naturally fluctuate throughout the day, timing and accuracy are critical. Blood work is often the first step, followed by confirmatory studies and imaging as needed.
Laboratory Tests Used to Diagnose Adrenal Disorders
Lab testing may be performed to measure hormone levels and evaluate how the adrenal glands respond to stimulation. Common tests include:
- ACTH stimulation test – This test assesses how the adrenal glands respond to adrenocorticotropic hormone by measuring cortisol levels before and after synthetic ACTH is administered. The results may point to adrenal insufficiency.
- 24-hour urine cortisol collection – The total amount of cortisol released into the urine is measured over a full day. This test is commonly used in evaluating Cushing’s syndrome.
- Serum aldosterone and plasma renin activity – If Conn’s syndrome is suspected, this test may be performed to check for aldosterone excess.
- Plasma or urine metanephrines – This test can detect catecholamine overproduction, which may indicate a pheochromocytoma.
Each lab test can pinpoint specific hormonal imbalances, guiding an accurate diagnosis.
Imaging Tests Used to Diagnose Adrenal Disorders
To check for structural abnormalities in the adrenal glands, the physician may order imaging, such as:
- Computed tomography (CT) scan – Can provide detailed images of an adrenal tumor or enlarged gland
- Magnetic resonance imaging (MRI) scan – Offers high-resolution images of soft tissues, which may be especially useful for characterizing an adrenal mass
- Ultrasound – May be used in select cases, particularly in pediatric patients, because it is safe, highly sensitive and radiation-free
Procedures Used to Diagnose Adrenal Disorders
In some cases, a diagnostic procedure may be needed to further evaluate an adrenal mass or clarify the source of hormone overproduction. These specialized techniques can help the physician differentiate between a benign and malignant growth or determine whether excess hormone production originates in the adrenal glands or elsewhere in the body. Accurate procedural testing can help ensure the patient receives the most appropriate and targeted treatment. Options may include:
- Fine needle aspiration (FNA) biopsy – May be performed to evaluate a suspicious adrenal mass, particularly to distinguish a primary adrenal tumor from metastatic disease
- Inferior petrosal sinus sampling – Can help the physician determine whether excess ACTH originates from the pituitary gland.
How Are Adrenal Disorders Treated?
Adrenal disorder treatment can vary based on the specific condition and whether hormone levels are elevated or deficient. Some adrenal disorders can be cured—particularly when caused by a removable tumor—but others may require lifelong hormone management.
Medication-Based Management for Adrenal Disorders
Medication is a first-line treatment for many adrenal disorders, especially when hormone levels are too high or too low. The goal of pharmacologic therapy is to restore hormonal balance, relieve symptoms and prevent complications. The specific medications prescribed can vary depending on whether the condition involves hormone deficiency, hormone excess or both. Options may include:
- Aldosterone antagonists, such as spironolactone and eplerenone, for hyperaldosteronism
- Alpha- or beta-blockers to stabilize blood pressure before pheochromocytoma surgery
- Glucocorticoid replacement therapy for adrenal insufficiency, which may involve hydrocortisone or prednisone
- Mineralocorticoid replacement (fludrocortisone) for aldosterone deficiency
- Steroidogenesis inhibitors, such as ketoconazole and metyrapone, to reduce cortisol production
Surgery for Adrenal Disorders
Adrenalectomy, which involves the surgical removal of one or both adrenal glands, may be considered for treating a hormone-producing or cancerous adrenal tumor. Because adrenal tumors can be complex, it is important to seek high-volume surgical expertise, which can reduce recovery time and enhance the outcome. An experienced surgeon may use minimally invasive laparoscopic techniques as appropriate.
What to Expect During Adrenal Disorder Treatment
Symptom improvement may begin within a few days to weeks after hormone levels are corrected, but full stabilization can take up to several months. Patients with chronic adrenal disorders typically require ongoing monitoring and medication adjustments.
What Are the Possible Complications of Adrenal Disorders?
If left untreated, an adrenal disorder can lead to potentially serious complications. Because adrenal hormones influence blood pressure, blood sugar, fluid balance and the body’s response to stress, even a small disruption can escalate over time. Some complications develop gradually, while others can quickly escalate into a medical emergency.
Adrenal Crisis
Adrenal crisis is a sudden, life-threatening drop in cortisol that the body cannot compensate for, especially during physical stress, such as infection, surgery, vomiting or injury. This may cause severe low blood pressure, dehydration, mental confusion and shock. Without immediate treatment, these effects can intensify rapidly. Emergency care is essential, typically involving the administration of intravenous (IV) fluids and steroids. For people with a known adrenal insufficiency, having an emergency action plan in place with injectable medication on hand can be lifesaving.
Cardiovascular Complications
Excess aldosterone or cortisol can strain the cardiovascular system over time. Too much aldosterone may cause the body to retain sodium and water while losing potassium, driving persistent high blood pressure and increasing the risk of abnormal heart rhythms (arrhythmias). Excess cortisol can worsen blood pressure, promote inflammation and contribute to changes in cholesterol and blood sugar that elevate the risk of heart disease and stroke.
Metabolic Complications
A prolonged cortisol imbalance can disrupt how the body processes sugar, fats and protein. Over time, excess cortisol may lead to insulin resistance or diabetes, weight gain and muscle weakness. It can also weaken bones, increasing the risk of osteoporosis and fractures, and contribute to thinning skin and slow wound healing. Without treatment, these metabolic effects can significantly affect long-term health and quality of life.
Can Adrenal Disorders Be Prevented or Detected Early?
Many adrenal disorders cannot be prevented, particularly those that are caused by an autoimmune process or genetic mutation. However, early detection and proactive health management can improve the outcome and reduce the risk of complications. Key steps include:
- Routine health screenings – Regular physical exams and targeted blood work are especially important for individuals with a family history of adrenal or autoimmune conditions. Early lab abnormalities may signal a developing hormonal imbalance before the symptoms become severe.
- Managing underlying medical conditions – Controlling blood pressure, diabetes and chronic stress can reduce strain on the endocrine system and help prevent secondary complications, such as worsening hormone imbalances, cardiovascular disease and metabolic complications like insulin resistance and osteoporosis.
- Environmental awareness – Avoiding unnecessary or prolonged corticosteroid use and discussing medication risks with a physician may help reduce the risk of secondary adrenal suppression.
How Can Adrenal Disorders Be Managed?
Long-term management of an adrenal disorder focuses on hormone balance and overall health. While treatment can vary by diagnosis, many people benefit from a consistent set of strategies, including:
- Lifestyle adjustments – A balanced diet, stress reduction, consistent sleep and regular exercise can support endocrine stability and improve day-to-day energy.
- Monitoring – Routine lab work and follow-up visits can help ensure any prescribed medications remain appropriately dosed and symptoms stay controlled.
- Supportive care – Connecting with a support group or mental health counselor may be helpful for navigating the emotional impact of a chronic hormonal condition.
TGH’s Approach to Adrenal Disorders
Tampa General Hospital’s Endocrinology Institute, in collaboration with the USF Health Diabetes and Endocrinology Program, offers comprehensive care for complex adrenal disorders, including advanced hormonal testing, high-resolution imaging and minimally invasive adrenal surgery. Our multidisciplinary team includes board-certified endocrinologists, endocrine surgeons, radiologists and specialized nursing staff who coordinate highly individualized treatment plans. For patients experiencing adrenal crisis, we deliver rapid emergency intervention backed by a nationally recognized academic medical center.
Take the next step toward expert endocrine care at Tampa General Hospital. To schedule an appointment or learn more about becoming a patient, call (855) 566-3627 or connect with one of our specialists. Consistently ranked by U.S. News & World Report among the nation’s top hospitals, TGH remains deeply committed to serving. the Tampa Bay community with leading-edge endocrine care