Adrenal glands: the glands of stress and more

They produce essential hormones, organise the body's reaction to physical or psychological stress, and control blood pressure and metabolism. The impact of tumors on their function.

The adrenal glands are two small endocrine organs situated just above the kidneys. Despite their small size, they produce crucial hormones vital for life, such as cortisol, aldosterone, adrenaline, and androgens. These hormones influence the body's response to stress, whether physical from illness or psychological, and also regulate blood pressure, metabolism, and numerous other bodily functions. Their significance to the body's proper functioning is highlighted by the fact that, if the adrenal glands are removed and their hormones are not replaced medically, there is a risk of death. However, the adrenal glands frequently develop small or larger tumors known as adenomas.

What are adrenal adenomas and how are they detected? The adrenal glands often have small or larger tumors known as adenomas. Adrenal adenomas are typically discovered accidentally during a CT or MRI scan of the abdomen conducted for unrelated reasons, which is why they are termed "incidentalalomas" in endocrinology. Research indicates that up to 1 in 10 individuals develop adrenal adenomas during their lifetime, although most remain unaware. Besides incidental radiological imaging of the abdomen, adenomas are diagnosed if they produce symptoms by overproducing certain adrenal hormones. However, since these symptoms are quite common in the general population, a thorough endocrinological evaluation, including medical history, clinical examination, and specific hormonal tests, is essential before recommending radiological imaging to identify adenomas. Lastly, it is important to note that adrenal tumors can very rarely be cancerous, but when they are, they tend to be highly aggressive.

What are the symptoms that may lead to the diagnosis? Many patients with adenomas have no symptoms. However, in recent years it has been found that a significant percentage of patients experience symptoms, mild or severe, depending on the hormone that is overproduced.

Adrenal adenomas can lead to: • Cushing's syndrome, which resembles the effects of taking high doses of cortisone, characterized by weight gain, predominantly central fat accumulation, muscle weakness, easy bruising or bleeding, difficulty climbing stairs, high blood pressure, diabetes mellitus, osteoporosis, and increased risk of infections and thrombosis. • Hypertension, which may be persistent and resistant to medication, or occur as hypertensive episodes with tachycardia, sweating, and headaches. It is now understood that a significant portion of hypertension, affecting over 1 in 10 patients, particularly younger individuals, is caused by adrenal hormones. • The development of hirsutism in women, acne, and other symptoms related to increased androgen production. Research has shown that adrenal adenomas can frequently overproduce hormones, though not in large amounts, resulting in milder symptoms.

Which tests are necessary? Based on the symptoms and the endocrinologist's assessment, initial tests may include hormonal blood and urine analyses. If these results are abnormal, more advanced hormonal tests might be needed, potentially requiring hospitalization. It is important to note that imaging of the adrenal glands using CT or MRI should be conducted only when there is definite clinical and laboratory evidence of a hormonal disorder, rather than as a primary diagnostic tool.

How are adrenal adenomas treated? If an adenoma is discovered to be producing excess hormones, the typical treatment involves laparoscopic surgical removal of the adrenal gland, often leading to a rapid improvement in symptoms. In certain situations, medication may be necessary before surgery or if the patient cannot undergo surgery for some reason.

What is the prognosis? If the adenoma is benign, non-hormone-producing, and asymptomatic, it only requires regular monitoring of its size and radiological appearance, typically on a yearly basis. When hormone-producing adenomas that cause symptoms are treated promptly, the prognosis is very favorable. However, a timely evaluation by a skilled Endocrinologist is essential to rule out malignancy, which has a poor prognosis, and to properly address a symptomatic benign adenoma.