You may not have spent much time thinking about your adrenal glands. But these two tiny triangular glands sit on top of each of your kidneys and play an important role in your everyday health. “The adrenal glands are responsible for hormones that we need to be alive and healthy,” says Tara Kim, a board-certified endocrinologist and assistant professor of clinical medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell on Long Island. The hormones these glands secrete help regulate our metabolism, immune system, blood pressure, and how our bodies respond to stress. We need them to be working well.
The trouble is it’s not always easy to tell when something is wrong with them, and there’s misinformation out there about what can actually go wrong with these powerhouses. That’s why we put together this guide to knowing when you might need to have your adrenals checked.
What you need to know about adrenal insufficiency
In rare cases, your adrenal glands stop producing enough of the hormones you need to be healthy, especially the stress hormone cortisol which helps your body do all kinds of things such as regulating blood pressure and controlling your sleep/wake cycle.
“There are many entities that can cause it,” says Kim, and two main ways it happens. The first is called primary adrenal insufficiency when your adrenals themselves are damaged in some way and so they stop producing enough of the hormones you need. The second is called secondary adrenal insufficiency when your pituitary gland (which is in charge of your adrenal glands) stops giving the right orders to your adrenals.
Causes of primary adrenal insufficiency:
- Autoimmune conditions such as Addison’s disease
- Some infections
- Genetics (some children are born without an enzyme that is needed to produce some of the hormones adrenal glands secrete)
Causes of secondary adrenal insufficiency:
- Long-term use of steroids, such as cortisol shots for pain or oral steroids can cause your body to “forget to make cortisol,” says Kim.
- Overuse or long-term use of opioid pain medications
- Traumatic brain injury
- Tumors on the pituitary gland
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Symptoms of adrenal insufficiency
- Lowered blood pressure
- Weight loss or inability to gain weight
- Muscle weakness or fatigue
- Muscle, joint or abdominal pains
- Menstrual irregularities
- Darkened skin (hyperpigmentation) in certain areas, especially the hands
If your adrenal insufficiency is severe, you may experience an adrenal crisis that makes you feel very ill, including symptoms such as dizziness or lightheadedness, severe nausea, vomiting or diarrhea, confusion, or loss of consciousness. If you are experiencing these symptoms or the darkening of your skin, you should call your provider immediately.
When your adrenals overproduce hormones
Adrenal cortisol excess — the opposite of adrenal insufficiency — happens when your adrenal glands are releasing too much cortisol. This condition, called Cushing’s Syndrome, can be caused by a growth on your pituitary or adrenal gland and certain cancers. Long-term use of corticosteroids, such as prednisone which is prescribed for autoimmune conditions, can also cause too much cortisol to be released.
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Symptoms of adrenal cortisol excess
- Excessive weight gain
- Deposits of fat in areas of your body such as your face and on your back where your spine meets your neck (creating a small hump)
- Thin skin that can tear easily and cause infection
- Purple stretch marks
- Loss of muscle
- High blood pressure
- Facial hair
Adrenal masses can also secrete other hormones, including aldosterone, which is a frequent cause of high blood pressure.
What about adrenal fatigue?
The term adrenal fatigue has gotten popular in the last few years, with a lot of websites offering supplements to treat it. The idea behind it is that “after certain situations, the adrenals get tired and they don’t make enough hormones,” says Kim. The problem, say experts in the field, is that there is no medical evidence that it is an actual condition.
“It’s really tough,” says Kim, “because people don’t feel well, and they want an answer.” And the symptoms attributed to so-called adrenal fatigue can be vague symptoms — fatigue, weight gain, depression — which are associated with a lot of conditions or with life in general. When people go online to search for them, says Kim, they may find information on adrenal fatigue that seems to fit their symptoms. But, “there’s not enough research to say that adrenal fatigue is a real phenomenon.” In fact, a study released in 2016, which looked at more than 50 scientific studies, concluded that adrenal fatigue does not exist.
In fact, a study released in 2016, which looked at more than 50 scientific studies, concluded that adrenal fatigue does not exist.
The danger with the concept, says Maria Fleseriu, MD, a board-certified endocrinologist and professor, and director of the Pituitary Center at Oregon Health & Science University, is that it can lead people to take treatments that have not been approved by the Food and Drug Administration. And those treatments can either cause health problems themselves, including true adrenal insufficiency, or delay people from getting the treatment they do need for another potentially serious, non-adrenal condition.
In 2020, the American Association of Clinical Endocrinologists and the American College of Endocrinology released a position statement cautioning the public about the dangers of adrenal supplements promoted to treat an “adrenal fatigue, an entity that has not been recognized as a legitimate medical diagnosis.”
“There are risks to taking adrenal supplements that are not FDA-approved,” says Kim. “We don’t know what’s in them, and, if they do contain actual hormones they can cause your body to forget to make its own hormones.”
What should I do if I am having symptoms of an adrenal condition?
“Primary care providers are an ideal place to start a discussion about adrenal dysfunction, especially adrenal insufficiency,” says Fleseriu. They can test your morning cortisol levels (the level changes throughout the day) to find out if your adrenals are producing a normal amount of cortisol. If the result is abnormal and there is a clear cause, such as taking opioids or high-dose steroids, then you can be treated by your primary care provider.
Sometimes the results of the morning cortisol test are borderline, and your provider may need to do additional tests to get a diagnosis. “If you need to find which type of adrenal insufficiency you have, patients will benefit from seeing an endocrinologist,” says Fleseriu. These physicians, who specialize in hormone disorders, can help you get to the cause of the problem and treat you with supplemental hormones that replace those your adrenals are not producing adequately, or possibly with surgery in the case of tumors.
The important thing is to make sure you find a healthcare provider who takes the time to get to the bottom of your symptoms. Fleseriu published a study in 2014 that found that 50% of women who experienced menstrual irregularities related to Cushing’s Syndrome were given a misdiagnosis of a polycystic ovarian syndrome (PCOS) instead. Her study recommends specific tests that providers should do in patients who have symptoms of cortisol excess.
None of the tests mentioned in this piece are part of your routine annual exam, but they are not difficult to do if you are experiencing symptoms that could be related to your adrenal glands. If they are, the sooner you begin treatment, the sooner you will feel better.