Adrenal disorders happen when the adrenal gland produces either too much or too little of cortisol or aldosterone. These two conditions create either Addison’s disease (your body does not have enough cortisol and aldosterone, or Cushing’s syndrome, where your body has too much cortisol. This post discusses the two diseases, treatment options, and how an endocrinologist is vital for diagnosing and helping people manage both conditions.
The endocrine system is a network of glands that create and emit various hormones that regulate bodily functions ranging from growth and development to reproduction. The adrenal gland is a part of the endocrine system, and is located on top of the kidneys. It produces cortisol and aldosterone, and other hormones that create homeostasis in the body. But sometimes this gland does not function properly, and can produce too little or not enough hormones, which can then lead to disease.
Addison’s disease is quite rare and is an adrenal insufficiency disorder. Without proper function of the adrenal gland, the body does not function at full capacity. Despite its rarity, it’s important for clinicians and other practitioners to understand the warning signs and treatment options. Symptoms for Addison’s disease can be non-specific and develop slowly. Signs include vomiting, diarrhea, abdominal pain, low blood pressure, darkening of the skin, fatigue, and weight loss. Patients also report nausea and loss of appetite. If these symptoms occur with sudden onset, then it’s a life-threatening event that requires emergency care.
Diagnosing the condition as an endocrinology-related disorder is tricky because the common symptoms can present as many other conditions. A skilled endocrinologist is needed to perform various tests. For example, the might order an ACTH stimulation test to see how the gland responds to the ACTH, which is a hormone that encourages the adrenal gland to create cortisol.
Once diagnosed, the endocrinologist and other care team members will create a course of action. This usually involves hormone replacement therapy in the form of medications that can replace the missing or depleted hormones. The doctor might order oral corticosteroids such as hydrocortisone or prednisone, as well as medications to replace aldosterone such as fludrocortisone. Patients will need to monitor their hormone levels frequently and stay in close contact with their doctors to ensure the treatment plan is well tolerated and effective. Patients also often need to take steps to avoid a Addisonian crisis, which is an emergency state. This could include a “med alert” bracelet, staying hydrated, and consuming additional medication if they are under stress.
With Cushing’s syndrome, the body creates too much cortisol through the adrenal gland for an extended period of time. The adrenal gland produces this hormone to help it regulate immune responses, blood sugar, and blood pressure.
Cushing’s syndrome is diagnosed through a series of tests. These include blood tests to measure cortisol levels and imaging tests to find the location of a possible tumor which could be the cause of the problem. If there is a tumor, surgery is often recommended by the endocrinologist. Other treatment options include medications such as ketoconazole or metyrapone and a more severe case of Cushing’s syndrome might require surgical removal of the adrenal gland.
An endocrinologist can help diagnose Cushing’s syndrome. They know the disease can be caused by the prolonged use of corticosteroid medications, such as prednisone which is often prescribed for asthma. Or a pituitary gland or adrenal gland tumor can disrupt the adrenal gland’s production. Diagnosing the condition is challenging because the symptoms can mimic other conditions. Your endocrinologist will conduct blood tests including a 24-hour urine cortisol test or a dexamethasone suppression test to measure cortisol production and levels. Tumors are spotted with an MRI or CT scan and treated surgically. If the cause is not a tumor, then the patient needs to taper off corticosteroid medications and might need some lifestyle changes for their diet or activity levels.
Patients with either condition should consult with an experienced endocrinology office that can quickly diagnose the problem, present the best treatment plan, and serve as a long-term ally for maintaining health. Dr. Brian Fertig is an experienced endocrinologist who can treat both Addison’s disease and Cushing’s syndrome. He is the Founder and President of the Diabetes & Osteoporosis Center in Piscataway, New Jersey, established in 1994. He is also the author of a respected text about the metabolic system called “Metabolism & Medicine” which you can buy today.