The adrenal glands are small, triangular-shaped glands that sit on top of both kidneys. Although they are small, adrenal glands are powerful hormone factories that regulate many functions of the body such as your metabolism, immune system, blood pressure, response to stress and other essential functions.

The role of the adrenal glands is to release certain hormones directly into the bloodstream. Both parts of the adrenal glands - the cortex and the medulla - perform different functions. The adrenal cortex makes and releases steroid hormones such as aldosterone and cortisol, and the adrenal medulla makes and releases “stress hormones” such as adrenaline and noradrenaline.

• Cortisol is your body’s main stress hormone. It works in conjunction with adrenaline and noradrenaline to help regulate your reaction to stress. Cortisol also plays an important role in several things your body does. It helps control the body’s metabolism by regulating how fats, proteins and carbohydrates are made and broken down. It also suppresses inflammation, regulates your blood pressure, increases your blood sugar and controls your sleep/wake cycle.

• Aldosterone helps control your blood pressure by managing the balance of potassium and sodium in your body.  

• Adrenaline and noradrenaline, also known as epinephrine and norepinephrine, control the opening and closing of blood vessels in the skin, control the strength and speed of the heartbeat and influence the muscles and internal organs. In stressful situations, their output is increased, which leads to a rapid pulse, higher blood pressure, shakiness, sweating, pallor and/or blanching of the skin. This prepares you for the “fight or flight” response.

There are multiple reasons why the adrenal glands might not work as they should. The adrenal gland may be producing too little or too much of certain hormones, which leads to hormonal imbalances. These abnormalities of the adrenal function can be caused by various diseases of the adrenal glands or the pituitary gland.

Common disorders and diseases of the adrenal glands include:

• Addison’s disease (primary adrenal insufficiency): Addison’s disease, or primary adrenal insufficiency, is a rare disorder that affects men and women of all ages. This condition occurs when the adrenal cortex fails to produce enough cortisol and aldosterone. Most cases of Addison’s disease are caused by an autoimmune response, which happens when the body’s immune system attacks its own organs and tissues. People with Addison's disease will need hormone replacement therapy for life.

• Adrenal hyperplasia (another type of adrenal insufficiency): Adrenal hyperplasia is a genetic disorder in which one of the enzymes necessary to produce adrenal hormones (cortisol, aldosterone or both) is missing or not functioning properly. Some disorders appear at birth and others are diagnosed later during development, usually around puberty.

• Adrenal tumors: Adrenal tumors can be divided into benign or malignant, functional (tumor cells are hormone-secreting) or non-functional (tumor cells are not hormone-secreting). Benign tumors that are non-functional are generally less harmful as they do not cause an imbalance in hormones and are not cancerous. Benign tumors that are functional secrete only one type of hormone (see below). Malignant (meaning cancerous) tumors make up less than 0.1% of all adrenal tumors and may secrete one or more adrenal hormones or none at all.

• Pheochromocytoma: A pheochromocytoma is a functional tumor of the adrenal medulla that overproduces adrenaline (epinephrine) and noradrenaline (norepinephrine). The hormones it produces lead to high blood pressure, palpitations, and other “flight or fight” symptoms, which can result in “crisis” under severe circumstances.

• Cushing’s syndrome: An excess of cortisol characterizes Cushing’s syndrome. It can be caused by a specific kind of tumor in the pituitary gland (a gland in the brain that influences the adrenals — which is then called Cushing’s disease) or by a tumor of the adrenal gland itself. More rarely, other tumors located elsewhere in the body can overstimulate the adrenal glands to produce too much cortisol. This disorder can also be caused by taking high levels of similar steroid hormones.

• Hyperaldosteronism: Hyperaldosteronism is a disease in which the adrenal glands make too much aldosterone, which leads to high blood pressure and low blood potassium levels. Primary hyperaldosteronism can be caused by either hyperactivity in one adrenal gland (unilateral disease) or both (bilateral disease).

Adrenal disorder symptoms vary depending on which hormones are being overproduced:

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• Cortisol: Too much cortisol can lead to Cushing’s syndrome. Symptoms of Cushing’s syndrome include fragile skin that bruises easily, pink, or purple stretch marks, high blood pressure, diabetes, fatigue, and confusion. Upper body obesity, increased fat around the back of the neck called a “Buffalo hump”, and thin arms and legs are also common.

• Aldosterone: Too much aldosterone can cause high blood pressure. It can also cause low levels of potassium. That may result in weakness, muscle aches, spasms, and sometimes paralysis.

• Epinephrine or norepinephrine: Too much of these hormones leads to high blood pressure, sudden and severe headaches, and anxiety symptoms.

• Androgenic steroids (androgen hormones): These include hormones related to testosterone. Having too much of them can lead to strong male traits in both men and women. These may include extra hair growth on the face and body, baldness, acne, a deeper voice and more muscle mass.

The symptoms of overactive adrenal glands may resemble other conditions or medical problems. See your health care provider for a diagnosis.

Testing for adrenal diseases can be complicated and often requires the help of an endocrinologist to understand what specific problems are occurring.

The hormones produced by the adrenal gland can be measured in the blood, urine, and saliva. If certain abnormalities are found, or you notice some of the signs and symptoms of an adrenal condition, it may be necessary to provide and examine one or more of those fluid samples.

Additionally, your health care provider may ask for imaging tests that look at the adrenal gland. These may include a CT scan, MRI, or specialized nuclear scans, which can help detect a tumor. Further testing of the pituitary gland may be necessary if your health care provider believes that there is a “secondary” cause for adrenal disease (such as a tumor or dysfunction of another gland that interacts with the adrenals). It is extremely important to consult with an expert in hormones (an endocrinologist) who can order and interpret the appropriate tests. Find endocrine care in your area.

There are several treatment options for adrenal disorders. As there are many different adrenal disorders, a specific diagnosis needs to be made for the correct treatment to be applied. In cases where the treatments are complicated, supervision by an endocrinologist is crucial.

Some conditions are treated with medication, whereas others need surgical treatment. In cases where hormones are missing, medications are given to correct the deficiency in the specific hormones. In cases where there are excess hormones, generally the treatment is surgical removal.