Adrenal, hormonal & endocrine care

Adrenal Disorders
& Hormonal Imbalances

The adrenal glands are two small, triangular-shaped glands located above the kidneys. Although small in size, they produce several essential hormones that help control blood pressure, blood sugar, metabolism, the body’s response to stress, salt and water balance, and certain aspects of sexual development. These hormones include cortisol, aldosterone, adrenaline, noradrenaline and adrenal androgens. Adrenal disorders occur when these glands produce too much or too little of a hormone, or when an abnormal growth develops within the gland. These conditions can affect newborn babies, children, young adults and older people. Some adrenal disorders cause obvious symptoms, while others develop silently and are discovered during investigations for high blood pressure, abnormal blood tests or abdominal scans.

Adrenal disorders can cause very different problems depending on which hormone is affected. Cortisol is an important hormone that helps maintain blood pressure, blood glucose and the body’s ability to respond to illness or physical stress. Too little cortisol can cause adrenal insufficiency, leading to severe tiredness, weakness, loss of appetite, weight loss, nausea, dizziness and low blood pressure. Too much cortisol can cause Cushing syndrome, which may lead to weight gain around the abdomen and face, muscle weakness, easy bruising, diabetes, hypertension and osteoporosis. Aldosterone helps regulate sodium, potassium and blood pressure. Excess aldosterone can cause high blood pressure and sometimes low potassium levels. Excess adrenaline or noradrenaline from a pheochromocytoma can cause episodes of severe hypertension, headaches, palpitations and sweating. Identifying the specific hormone abnormality is essential because the treatment is different for each condition.

Adrenal insufficiency is an important condition because cortisol is essential for survival. Primary adrenal insufficiency, commonly called Addison’s disease, develops when the adrenal glands cannot produce enough cortisol and sometimes aldosterone. It may occur because of autoimmune destruction of the adrenal glands, infections including tuberculosis, certain genetic disorders or other adrenal diseases. Secondary adrenal insufficiency occurs when the pituitary gland does not produce enough ACTH, the hormone that stimulates cortisol production. Long-term use of steroid medicines, followed by inappropriate or abrupt withdrawal, can also suppress normal cortisol production. Patients may experience persistent fatigue, unexplained weight loss, low blood pressure, nausea, abdominal discomfort or recurrent low sodium levels. Some people with primary adrenal insufficiency develop increased skin pigmentation and salt craving. Early diagnosis and appropriate hormone replacement are important to prevent adrenal crisis, a potentially life-threatening emergency associated with severe low blood pressure, vomiting, dehydration and circulatory collapse.

Excess cortisol production, called Cushing syndrome, may initially resemble common problems such as obesity, diabetes or hypertension. Patients may develop increasing abdominal fat, a rounded face, wide purple stretch marks, easy bruising, thin skin, poor wound healing, muscle weakness and bone loss. Women may experience irregular periods, acne or excessive facial hair. Children may show weight gain associated with poor height growth. Cushing syndrome can result from prolonged exposure to steroid medicines or from the body’s excessive production of cortisol. The source may be a pituitary ACTH-producing tumour, called Cushing disease, an adrenal tumour or, less commonly, ACTH production elsewhere in the body. Routine blood cortisol levels alone cannot reliably diagnose Cushing syndrome. Appropriate screening tests, followed by specialised hormonal evaluation when indicated, are necessary to establish the diagnosis and identify the source.

Some patients with high blood pressure have a treatable adrenal hormonal disorder. One important example is primary aldosteronism, a condition in which one or both adrenal glands produce excessive aldosterone. This causes sodium retention, suppression of renin, increased blood pressure and sometimes potassium loss. Many patients with primary aldosteronism have normal potassium levels, so the disorder cannot be excluded simply because potassium is normal. It is particularly important to consider hormonal causes in patients with hypertension at a young age, difficult-to-control blood pressure or an adrenal nodule. Screening usually involves measuring aldosterone and renin and interpreting the aldosterone-to-renin ratio (ARR). Depending on the findings, further evaluation helps determine whether the excess hormone production comes from one adrenal gland or both. Selected patients may benefit from adrenal surgery, while others can be treated effectively with specific medicines that block aldosterone action.

Pheochromocytoma is an uncommon but important adrenal tumour that can cause potentially dangerous episodes of high blood pressure. It develops from cells that produce catecholamines such as adrenaline and noradrenaline. Patients may experience sudden episodes of headache, excessive sweating, palpitations, tremors, anxiety and marked increases in blood pressure. Some have persistent hypertension, while others may have normal blood pressure between episodes. Similar tumours occurring outside the adrenal gland are called paragangliomas. These conditions require specialised hormonal testing, usually using plasma free metanephrines or urinary fractionated metanephrines, followed by appropriate imaging. Treatment often involves surgical removal, but careful medical preparation before surgery is essential to reduce the risk of severe cardiovascular complications. Some pheochromocytomas and paragangliomas are associated with inherited genetic conditions, making genetic counselling and family evaluation important in selected patients.

Not every adrenal tumour is cancer, and not every adrenal swelling requires surgery. Adrenal nodules or masses are sometimes discovered unexpectedly during CT or MRI scans performed for abdominal pain, kidney stones or unrelated medical problems. These are called adrenal incidentalomas. Most are benign and do not produce clinically significant excess hormones. However, some adrenal masses produce cortisol, aldosterone or catecholamines, while a smaller proportion may have suspicious imaging features suggesting malignancy. A detailed evaluation considers the size, appearance and imaging characteristics of the lesion, together with appropriate hormonal investigations. Some patients have mild autonomous cortisol secretion, in which an adrenal nodule produces excess cortisol without the typical physical appearance of Cushing syndrome. This may contribute to diabetes, hypertension or other metabolic complications. Correct evaluation helps distinguish harmless lesions requiring little or no further monitoring from conditions requiring specific treatment.

Adrenal disorders can also affect babies, children and adolescents. Congenital adrenal hyperplasia (CAH) is a group of inherited disorders in which the adrenal glands cannot produce certain hormones normally. The most common form involves 21-hydroxylase deficiency, which can reduce cortisol production and, in severe cases, aldosterone production while increasing adrenal androgen levels. Some affected newborns develop dangerous salt loss, dehydration, vomiting and low blood pressure during the first weeks of life. Other children may develop early pubic hair, rapid childhood growth, advanced bone age or unusual genital development. Non-classical congenital adrenal hyperplasia may become apparent later through acne, excessive facial hair or menstrual irregularities. These conditions require appropriate hormonal investigations and individualised treatment. Early diagnosis helps protect health, support normal growth and puberty, and reduce the risk of adrenal emergencies.

A detailed endocrine evaluation is essential because adrenal hormone tests require careful selection and interpretation. Depending on the suspected condition, investigations may include morning cortisol, ACTH, ACTH stimulation testing, sodium, potassium, aldosterone, renin, plasma or urinary metanephrines, and specialised cortisol suppression tests. Selected patients may require adrenal CT or MRI, genetic evaluation or additional hormone measurements. The timing of tests, patient position, medicines, recent illness and other factors can influence certain results. For example, blood pressure medicines may alter aldosterone and renin measurements, and steroid treatment can interfere with cortisol testing. A single abnormal laboratory value does not always establish an adrenal disorder. Similarly, an adrenal mass should not undergo biopsy without appropriate assessment, particularly exclusion of pheochromocytoma when relevant.

Many adrenal disorders can be successfully managed with the correct diagnosis and treatment. Patients with adrenal insufficiency generally require replacement of deficient hormones and education about increasing glucocorticoid treatment during significant illness or physical stress. Some patients with Cushing syndrome, primary aldosteronism or pheochromocytoma may benefit from surgery, while others require specific medicines or long-term monitoring. Patients with adrenal incidentalomas need management based on hormonal activity and imaging characteristics rather than tumour size alone. Children with congenital adrenal disorders may require ongoing hormonal treatment and monitoring of growth and pubertal development. The aim is not simply to normalise laboratory values but to protect cardiovascular, metabolic, bone and overall health.

Dr. Rajesh Moganti (MD, DM Endocrinology) provides comprehensive evaluation and personalised management of adrenal insufficiency, Addison’s disease, Cushing syndrome, primary aldosteronism, pheochromocytoma, adrenal incidentalomas, adrenal tumours and congenital adrenal hyperplasia at our Rajahmundry and Tanuku centres. Care focuses on identifying the exact hormonal disorder, selecting appropriate diagnostic tests, providing evidence-based treatment and preventing long-term complications. Patients who require adrenal surgery, specialised genetic evaluation or complex hospital-based care receive coordinated management with the relevant specialists.