The Adrenal Glands

CLINICAL CONTEXT

The Adrenal Glands: cortisol, aldosterone, and endocrine emergencies

The paired adrenal glands sit above the kidneys but are endocrine organs, not part of the urinary tract. Each contains an outer cortex and inner medulla. The zona glomerulosa produces aldosterone under renin-angiotensin and potassium control; the zona fasciculata produces cortisol under hypothalamic-pituitary ACTH signalling; and the zona reticularis produces adrenal androgens. Chromaffin cells of the medulla release catecholamines during sympathetic activation. These hormones influence blood pressure, sodium and potassium balance, glucose metabolism, inflammation, stress response, and cardiovascular function. Symptoms of gland disease can be subtle and overlap with common conditions, so biochemical confirmation and careful interpretation are central.

Common disorders and presentations

Primary adrenal insufficiency, often autoimmune Addison disease, reduces cortisol and frequently aldosterone. Patients may report persistent fatigue, weakness, weight loss, nausea, abdominal pain, salt craving, postural dizziness, and skin or mucosal hyperpigmentation. Secondary or tertiary insufficiency follows pituitary or hypothalamic disease; prolonged glucocorticoid use followed by abrupt withdrawal is a frequent cause of tertiary suppression. Adrenal crisis can be triggered by infection, surgery, trauma, vomiting, or missed replacement and may present with hypotension, dehydration, abdominal symptoms, hypoglycaemia, electrolyte disturbance, confusion, or shock. At the other extreme, Cushing syndrome reflects prolonged cortisol excess, due to prescribed glucocorticoids or endogenous causes such as pituitary ACTH disease or adrenal tumours. Phaeochromocytoma may cause episodic headache, sweating, palpitations, and hypertension. Incidental adrenal masses need risk-based hormonal and imaging assessment rather than reflex assumptions about malignancy or function.

Conventional assessment and management

History should include current and recent steroid exposure, inhaled or topical formulations, supplements, cancer treatments, autoimmune disease, and symptoms over time. Examination assesses blood pressure including postural change, volume status, skin, weight, muscle strength, and features of hormone excess. Cortisol, ACTH, renin, aldosterone, electrolytes, glucose, and stimulation or suppression tests are selected and interpreted using appropriate timing and specialist protocols. Imaging is used when biochemical findings support a structural cause. Confirmed adrenal insufficiency requires glucocorticoid replacement, often mineralocorticoid replacement in primary disease, education about dose adjustment during illness, emergency injectable steroid where prescribed, and medical-alert identification. Cushing syndrome treatment depends on cause and may include supervised reduction of exogenous steroids, surgery, radiotherapy, or cortisol-lowering medicines. Patients should never abruptly discontinue long-term glucocorticoids without the prescribing clinician’s plan.

Complementary approaches and safety

Nutrition, hydration, sleep, and psychological support can help wellbeing but cannot replace essential hormone replacement or treat cortisol excess. Over-the-counter “adrenal support” supplements may contain undeclared steroids or stimulants and can interfere with testing and treatment. Adaptogen claims are not a substitute for endocrine evaluation. During illness, vomiting, or inability to keep oral medication down, people with known adrenal insufficiency need to follow their emergency plan and seek immediate medical care. Collapse, severe abdominal or back pain, confusion, persistent vomiting, or very low blood pressure may indicate adrenal crisis and is life-threatening. This page is for clinical education, not self-diagnosis.

Further reading: NIDDK: adrenal insufficiency facts · NIDDK: symptoms and causes · NIDDK: Cushing syndrome

Clinical communication and follow-up

Explain the working diagnosis, important alternatives, planned tests, expected course, and specific safety-netting in language the patient can use. Invite questions about treatment goals, capacity, cost, culture, and complementary therapies. Use a professional interpreter when language access could affect consent or understanding, and confirm clear arrangements for timely clinical review in writing. Document the reasoning, reassess response to treatment, and coordinate care across professions when illness affects more than one system. Teaching anatomy is most useful when it supports this partnership: accurate localisation, respectful listening, timely escalation, and a plan that remains responsive to the individual patient.