Adrenal Disorders

The adrenal glands sit one above each kidney and produce three groups of hormones that the body cannot manage without: cortisol, which maintains blood pressure and blood sugar and lets you withstand illness; aldosterone, which controls sodium, potassium and blood pressure; and adrenal androgens. The inner part makes adrenaline.

Problems come in three shapes. The glands can produce too much of one hormone, usually because of a benign growth in the gland or a signal from the pituitary above it. They can produce too little, from autoimmune destruction, from tuberculosis, which remains an important cause in India, or from bleeding into the gland. Or a lump is found on a scan done for something else entirely, and the question becomes whether it is producing anything and whether it looks harmless.

There is a fourth and commoner route into this clinic. Steroid medication taken for weeks or months switches off the body's own production, so the glands cannot respond when it is stopped or when illness arrives.

Your doctor works from a history that covers slowly accumulating changes, since adrenal disease develops over months and people adapt to it. They will ask about weight and where it settled, bruising, stretch marks, muscle weakness in the thighs, blood pressure, salt craving, dizziness on standing, darkening of the skin, cycles and mood, and about every steroid you have taken by any route.

The examination measures blood pressure lying and standing, and looks at the distribution of weight, the skin for thinning, bruising and pigmentation in the creases, the gums, old scars, and the strength of the muscles around the hips.

Hormone testing is timed and often repeated, because these hormones follow a daily rhythm, and stimulation or suppression tests are used to establish whether a gland responds as it should. Imaging follows the hormone results instead of leading them, and a lump found first is assessed for what it produces.

Replacement for an underactive gland works quickly. Energy and appetite improve within days to a few weeks, and the dose is adjusted at review. Replacement continues for life, and your endocrinologist will teach you sick-day rules, give you a card or bracelet to carry, and often an emergency injection to keep at home.

After an operation to remove a gland or a growth, expect two to four days in hospital for a keyhole approach and two to four weeks off work.

Where a growth had been producing cortisol, recovery afterwards is slow. The other gland has been switched off and takes six to eighteen months to resume its own output, during which you continue replacement on a reducing dose and feel tired and achy while the body readjusts. Blood pressure, blood sugar and bone density improve over the same period.