The adrenal glands are small glands located on top of each kidney. They produce hormones that you can't live without, including sex hormones and cortisol. Cortisol helps you respond to stress and has many other important functions.

With adrenal gland disorders, your glands make too much or not enough hormones. In Cushing's syndrome, there's too much cortisol, while with Addison's disease, there is too little. Some people are born unable to make enough cortisol.

Causes of adrenal gland disorders include

• Genetic mutations
• Tumors including pheochromocytomas
• Infections
• A problem in another gland, such as the pituitary, which helps to regulate the adrenal gland
• Certain medicines

Treatment depends on which problem you have. Surgery or medicines can treat many adrenal gland disorders.

The adrenal glands, located on the top of each kidney, are responsible for releasing different hormones. Adrenal gland disorders occur when the adrenal glands produce too much or too little of these hormones.

What are the adrenal glands?

The adrenal glands, located on the top of each kidney, are responsible for releasing different classes of hormones.

The outer part of the gland, called the adrenal cortex, produces the hormones cortisol (pronounced KAWR-tuh-sohl) and aldosterone (pronounced al-DOS-tuh-rohn). The inner part of the gland, called the adrenal medulla (pronounced muh-DUHL-uh), produces the hormones adrenaline and noradrenaline.

These hormones—cortisol, aldosterone, adrenaline, and noradrenaline—control many important functions in the body, including:

• Maintaining metabolic processes, such as managing blood sugar levels and regulating inflammation
• Regulating the balance of salt and water
• Controlling the "fight or flight" response to stress
• Maintaining pregnancy
• Initiating and controlling sexual maturation during childhood and puberty

The adrenal glands are also an important source of sex steroids, such as estrogen and testosterone.

What are adrenal gland disorders?

Adrenal gland disorders occur when the adrenal glands do not work properly. They can be classified into disorders that occur when too much hormone is produced or when too little hormone is produced.

These disorders can occur if there is a problem with the adrenal gland itself, such as a disease, genetic mutation, tumor, or infection. Or, sometimes the disorder results from a problem in another gland, such as the pituitary, which helps to regulate the adrenal gland. In addition, some medications can cause problems with how the adrenal glands function. When the adrenal glands produce too little or too many hormones, or when too many hormones come into the body from an outside source, serious health problems can develop.

Overall, adrenal gland disorders are generally rare. The number of people affected and at risk depends on the specific type of adrenal gland disorder.

The adrenal, or suprarenal, gland is paired with one gland located near the upper portion of each kidney. Each gland is divided into an outer cortex and an inner medulla. The cortex and medulla of the adrenal gland, like the anterior and posterior lobes of the pituitary, develop from different embryonic tissues and secrete different hormones. The adrenal cortex is essential to life, but the medulla may be removed with no life-threatening effects.

The hypothalamus of the brain influences both portions of the adrenal gland but by different mechanisms. The adrenal cortex is regulated by negative feedback involving the hypothalamus and adrenocorticotropic hormone; the medulla is regulated by nerve impulses from the hypothalamus.

Hormones of the Adrenal Cortex

The adrenal cortex consists of three different regions, with each region producing a different group or type of hormones. Chemically, all the cortical hormones are steroid.

Mineralocorticoids are secreted by the outermost region of the adrenal cortex. The principal mineralocorticoid is aldosterone, which acts to conserve sodium ions and water in the body. Glucocorticoids are secreted by the middle region of the adrenal cortex. The principal glucocorticoid is cortisol, which increases blood glucose levels.

The third group of steroids secreted by the adrenal cortex is the gonadocorticoids, or sex hormones. These are secreted by the innermost region. Male hormones, androgens, and female hormones, estrogens, are secreted in minimal amounts in both sexes by the adrenal cortex, but their effect is usually masked by the hormones from the testes and ovaries. In females, the masculinization effect of androgen secretion may become evident after menopause, when estrogen levels from the ovaries decrease.

Hormones of the Adrenal Medulla

The adrenal medulla develops from neural tissue and secretes two hormones, epinephrine and norepinephrine. These two hormones are secreted in response to stimulation by sympathetic nerve, particularly during stressful situations. A lack of hormones from the adrenal medulla produces no significant effects. Hypersecretion, usually from a tumor, causes prolonged or continual sympathetic responses.

The adrenal glands are wedges of glandular and neuroendocrine tissue adhering to the top of the kidneys by a fibrous capsule (Figure). The adrenal glands have a rich blood supply and experience one of the highest rates of blood flow in the body. They are served by several arteries branching off the aorta, including the suprarenal and renal arteries. Blood flows to each adrenal gland at the adrenal cortex and then drains into the adrenal medulla. Adrenal hormones are released into the circulation via the left and right suprarenal veins.

The adrenal gland consists of an outer cortex of glandular tissue and an inner medulla of nervous tissue. The cortex itself is divided into three zones: the zona glomerulosa, the zona fasciculata, and the zona reticularis. Each region secretes its own set of hormones.

The adrenal cortex, as a component of the hypothalamic-pituitary-adrenal (HPA) axis, secretes steroid hormones important for the regulation of the long-term stress response, blood pressure and blood volume, nutrient uptake and storage, fluid and electrolyte balance, and inflammation. The HPA axis involves the stimulation of hormone release of adrenocorticotropic hormone (ACTH) from the pituitary by the hypothalamus. ACTH then stimulates the adrenal cortex to produce the hormone cortisol. This pathway will be discussed in more detail below.

The adrenal medulla is neuroendocrine tissue composed of postganglionic sympathetic nervous system (SNS) neurons. It is really an extension of the autonomic nervous system, which regulates homeostasis in the body. The sympathomedullary (SAM) pathway involves the stimulation of the medulla by impulses from the hypothalamus via neurons from the thoracic spinal cord. The medulla is stimulated to secrete the amine hormones epinephrine and norepinephrine.

One of the major functions of the adrenal gland is to respond to stress. Stress can be either physical or psychological or both. Physical stresses include exposing the body to injury, walking outside in cold and wet conditions without a coat on, or malnutrition. Psychological stresses include the perception of a physical threat, a fight with a loved one, or just a bad day at school.

The body responds in different ways to short-term stress and long-term stress following a pattern known as the general adaptation syndrome (GAS). Stage one of GAS is called the alarm reaction. This is short-term stress, the fight-or-flight response, mediated by the hormones epinephrine and norepinephrine from the adrenal medulla via the SAM pathway. Their function is to prepare the body for extreme physical exertion. Once this stress is relieved, the body quickly returns to normal. The section on the adrenal medulla covers this response in more detail.

If the stress is not soon relieved, the body adapts to the stress in the second stage called the stage of resistance. If a person is starving for example, the body may send signals to the gastrointestinal tract to maximize the absorption of nutrients from food.

If the stress continues for a longer term however, the body responds with symptoms quite different than the fight-or-flight response. During the stage of exhaustion, individuals may begin to suffer depression, the suppression of their immune response, severe fatigue, or even a fatal heart attack. These symptoms are mediated by the hormones of the adrenal cortex, especially cortisol, released as a result of signals from the HPA axis.

Adrenal hormones also have several non–stress-related functions, including the increase of blood sodium and glucose levels, which will be described in detail below.

Overview

The adrenal glands, located superior to each kidney, consist of two regions: the adrenal cortex and adrenal medulla. The adrenal cortex—the outer layer of the gland—produces mineralocorticoids, glucocorticoids, and androgens. The adrenal medulla at the core of the gland produces epinephrine and norepinephrine.

The adrenal glands mediate a short-term stress response and a long-term stress response. A perceived threat results in the secretion of epinephrine and norepinephrine from the adrenal medulla, which mediate the fight-or-flight response. The long-term stress response is mediated by the secretion of CRH from the hypothalamus, which triggers ACTH, which in turn stimulates the secretion of corticosteroids from the adrenal cortex. The mineralocorticoids, chiefly aldosterone, cause sodium and fluid retention, which increases blood volume and blood pressure.

There are several types of adrenal gland disorders, each with its own symptoms and treatments.

Adrenal Gland Tumors

Most adrenal gland tumors—abnormal growths on the adrenal glands—are not cancerous. They often do not cause symptoms or require treatment. However, adrenal gland tumors can produce a variety of different hormones, leading hormone levels to get too high.

Adrenal tumors can cause:

• Cushing's syndrome, by producing cortisol so that body levels get too high
• Primary hyperaldosteronism, by creating high levels of the hormone aldosterone (controls blood pressure and body salt and potassium levels)
• Pheochromocytoma, by producing too much adrenaline (regulates the "fight-or-flight" response)

Adrenocortical Carcinoma

This is a cancerous adrenal tumor that tends to develop in the outer layer of the adrenal gland. Cancerous adrenal tumors are often found years after they start growing, at which point the cancer have spread to other organs.

Cushing Syndrome

Cushing syndrome is a rare disease that results from having too much cortisol hormone in the body. In some cases, Cushing syndrome develops from long-term or overuse of steroid medications(medicines that act like cortisol in the body). In other cases, the body itself produces too much cortisol. This overproduction can happen for several reasons, including the presence of tumors(abnormal growths) such as a:

• Tumor of the pituitary gland (this is called Cushing disease)
• Tumor of the adrenal gland (as explained above)
• Tumor in another part of the body (these are called "ectopic" tumors and are more commonly found in the pancreas, lung, or the thyroid gland)

Congenital Adrenal Hyperplasia (CAH)

CAH is a common genetic disorder in which the body makes too little cortisol. People with CAH may also have other hormone imbalances. For example, their bodies might not make enough aldosterone (controls blood pressure and body salt and potassium levels), but might make too much androgen (promotes the development of male sexual organs).

Pituitary Tumors

The pituitary gland is located at the base of the brain. It releases hormones that affect many of the body's functions. Among those hormones is the adrenocorticotropic (pronounced a-DREE-noh kawr-tuh-koh-TRO-pic) hormone (ACTH), which stimulates the adrenal glands to release the hormone cortisol.

Sometimes, benign (noncancerous) pituitary tumors or—more rarely cancerous tumors—may grow on the pituitary gland, which can cause a variety of problems. Some pituitary tumors release too much ACTH, which, in turn, can cause the adrenal glands to produce too much cortisol. Cushing's disease refers to pituitary tumors that cause Cushing's syndrome.

Pheochromocytoma

Pheochromocytomas (pronounced fee-oh-kroh-moh-sigh-TOH-muhs) are part of a larger family of tumors, called paragangliomas (pronounced pair-uh-gang-lee-OH-muhs). Pheochromocytoma is a type of tumor that develops in the adrenal medulla, the inner part of the adrenal gland. It produces adrenaline, causing high levels of this hormone in the body. In most cases, the tumors are not cancerous and do not spread to other parts of the body. But in about 10% of cases, the tumors are cancerous and can spread.

Adrenal Gland Suppression

The normal activity of the adrenal glands can be suppressed—or reduced—when people take steroid medications (medicines that act like cortisol in the body) such as prednisone, hydrocortisone, or dexamethasone. Steroid medications, most often prednisone, may be prescribed to treat certain types of arthritis, severe allergic reactions, asthma, autoimmune (pronounced awh-toh-im-YOON) diseases, and other conditions.

Ordinarily, someone taking steroids takes gradually lower and lower doses as time goes by until they stop taking the drug completely. This is called "tapering" the dose. When steroid medications are stopped suddenly, especially after being taken for several weeks or more, the adrenal glands may be unable to produce steroid hormones (most importantly, cortisol) in sufficient amounts for several weeks or even months. This situation can cause health problems because of the imbalance of hormone levels that continues until the adrenal glands start functioning normally again.

Addison's Disease

This rare disorder develops when the adrenal glands do not make enough cortisol. In most cases of Addison's disease, the body also doesn't make enough of the hormone aldosterone.

Addison's is an autoimmune disease—a condition in which the immune system, which is supposed to protect the body, mistakenly attacks the body's own tissues and cells. In the case of Addison's disease, this reaction results in damage to the adrenal glands. In the long term, this damage can get worse until eventually the adrenal glands aren't working at all.

Hyperaldosteronism

This disorder occurs when the body produces too much aldosterone, a hormone that controls blood pressure and regulates the body's salt and potassium levels. The extra aldosterone is produced either by a tumor, which typically affects one adrenal gland, or by abnormal growth of both glands, a condition called "hyperplasia."

Pheochromocytoma is a rare tumor that usually starts in the cells of one of your adrenal glands. Although they are usually benign, pheochromocytomas often cause the adrenal gland to make too many hormones. This can lead to high blood pressure and cause symptoms such as

• Headaches
• Sweating
• Pounding of the heart
• Being shaky
• Being extremely pale

Sometimes pheochromocytoma is part of another condition called multiple endocrine neoplasia syndrome (MEN). People with MEN often have other cancers and other problems involving hormones.

Doctors use lab tests and imaging tests to diagnose it. Surgery is the most common treatment. Other options include radiation therapy, chemotherapy, and targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells.

Cushing's syndrome is a hormonal disorder. The cause is long-term exposure to too much cortisol, a hormone that your adrenal gland makes. Sometimes, taking synthetic hormone medicine to treat an inflammatory disease leads to Cushing's. Some kinds of tumors produce a hormone that can cause your body to make too much cortisol.

Cushing's syndrome is rare. Some symptoms are

• Upper body obesity
• Thin arms and legs
• Severe fatigue and muscle weakness
• High blood pressure
• High blood sugar
• Easy bruising

Lab tests can show if you have it and find the cause. Your treatment will depend on why you have too much cortisol. If it is because you have been taking synthetic hormones, a lower dose may control your symptoms. If the cause is a tumor, surgery and other therapies may be needed.

Your adrenal, or suprarenal, glands are located on the top of each kidney. These glands produce hormones that you can't live without, including sex hormones and cortisol, which helps you respond to stress and has many other functions.

A number of disorders can affect the adrenal glands, including tumors. Tumors can be either benign or malignant. Benign tumors aren't cancer. Malignant ones are. Most adrenal gland tumors are benign. They usually do not cause symptoms and may not require treatment. Malignant adrenal gland cancers are uncommon.

Types of tumors include

• Adrenocortical carcinoma - cancer in the outer part of the gland
• Neuroblastoma, a type of childhood cancer
• Pheochromocytoma - a rare tumor that is usually benign

Symptoms depend on the type of cancer you have. Treatments may include surgery, chemotherapy, or radiation therapy.

Your adrenal glands are just above your kidneys. The outside layer of these glands makes hormones that help your body respond to stress and regulate your blood pressure and water and salt balance. Addison disease happens if the adrenal glands don't make enough of these hormones.

A problem with your immune system usually causes Addison disease. The immune system mistakenly attacks your own tissues, damaging your adrenal glands. Other causes include infections and cancer.

Symptoms include

• Weight loss
• Muscle weakness
• Fatigue that gets worse over time
• Low blood pressure
• Patchy or dark skin

Lab tests can confirm that you have Addison disease. If you don't treat it, it can be fatal. You will need to take hormone pills for the rest of your life. If you have Addison disease, you should carry an emergency ID. It should say that you have the disease, list your medicines and say how much you need in an emergency.

The adrenal glands, located on the top of each kidney, are responsible for releasing different hormones. Adrenal gland disorders occur when the adrenal glands produce too much or too little of these hormones.

Cushing's Syndrome

Common symptoms of Cushing's syndrome (due to an adrenal, pituitary, or ectopic tumor) can include:

• Upper body obesity, round face and neck, and thinning arms and legs
• Skin problems, such as acne or reddish-blue streaks on the abdomen or underarm area
• High blood pressure
• Muscle and bone weakness
• Moodiness, irritability, or depression
• High blood sugars
• Slow growth rates in children

Women may also have increased growth of hair on their face and body and experience menstrual irregularities. Men may become less fertile and have a reduced or absent sex drive.

Congenital Adrenal Hyperplasia (CAH)

Symptoms of CAH range from mild to serious. Some people with mild CAH are never diagnosed because their symptoms do not cause them any problems.
Symptoms of the mild form of CAH, which can be diagnosed in children or adults, may include:

• Shorter than average final height
• Early signs of puberty (in children)
• Acne
• Irregular menstrual periods and possible trouble getting pregnant (in women)
• Excess facial hair (in women)

Symptoms of the severe form of CAH, which is diagnosed in children, may include:

• Dehydration
• Low blood pressure
• Low blood sugar level
• Trouble keeping enough salt in the body
• Altered development of the external genitalia in girls, which is noted at birth and may require surgery to correct
• Shorter than average final height
• Early signs of puberty
• Irregular periods and possible trouble getting pregnant (in women)
• Excess facial hair (in women)
• Benign testicular tumors and infertility (in men)

Pituitary Tumors

The symptoms of functioning pituitary tumors depend on the particular hormone the tumor is overproducing.

Too much prolactin may cause:

• Headache
• Some loss of vision
• Less frequent or no menstrual periods or menstrual periods with a very light flow
• Difficulty getting pregnant
• Impotence in men
• Lower sex drive
• The flow of breast milk in a woman who is not pregnant or breastfeeding

Too much adrenocorticotropic hormone (ACTH) may cause:

• Headache
• Some loss of vision
• Weight gain reflected in the face, neck, and trunk of the body, but thin arms and legs
• A lump of fat on the back of the neck
• Thin skin that may include purple or pink stretch marks on the chest or abdomen
• Easy bruising
• Growth of fine hair on the face, upper back, or arms
• Bones that break easily
• Anxiety, irritability, depression
• Growth deceleration with weight gain in children
• Irregular menses

Too much growth hormone may cause:

• Headache
• Some loss of vision
• In adults, growth of the bones in the face, hands, and feet
• In children, excessive growth of the whole body
• Tingling or numbness in the hands and fingers
• Snoring or pauses in breathing during sleep
• Joint pain
• Sweating more than usual
• Extreme dislike of or concern about one or more parts of the body

Too much thyroid-stimulating hormone (TSH) may cause:

• Irregular heartbeat
• Shakiness
• Weight loss
• Trouble sleeping
• Frequent bowel movements
• Sweating

Nonfunctioning tumors press on or damage the pituitary and prevent it from secreting enough hormones. If there is too little of a particular hormone, the gland or organ it normally controls will not function correctly. Symptoms of nonfunctioning pituitary tumors are:

• Headache
• Some loss of vision
• Loss of body hair
• In women, less frequent menstrual periods or no periods at all, or no milk from the breasts
• In men, loss of facial hair, growth of breast tissue, and impotence
• In women and men, lower sex drive
• In children, slowed growth and sexual development

Other general symptoms of pituitary tumors include the following:

• Nausea and vomiting
• Confusion
• Dizziness
• Seizure
• Runny or drippy nose

Pheochromocytoma/Paraganglioma

Most people with pheochromocytoma have high blood pressure (hypertension) because the tumor causes the adrenal gland to produce too much adrenaline or noradrenaline. Other symptoms may include:

• Rapid heart rate
• Headache
• Sweating
• Episodes of high or low blood pressure
• Anxiety or panic attack
• Shaking (tremors) of the hands
• Pale skin
• Blurred vision
• Weight loss
• Constipation
• Abdominal pain
• High blood sugar
• Psychiatric disturbances

Addison's Disease

Symptoms can vary, depending on what causes the disease. Symptoms typically include:

• Weight loss
• Weakness
• Extreme fatigue
• Nausea and/or vomiting
• Low blood pressure
• Patches of darker skin
• Craving for salt
• Dizziness upon standing
• Depression

Hyperaldosteronism

The main symptom is moderate to high blood pressure (hypertension), which can be difficult to control. Other symptoms include:

• Low potassium levels
• Muscle cramping or spasms
• Excessive urination, sometimes at night
• Headache
• Generalized weakness

Adrenal gland disorders are caused by problems with one or both adrenal glands or by problems with other glands, such as the pituitary gland.

Specific disorders can develop when the adrenal glands produce too few or too many hormones, or when too many hormones are introduced from an outside source.

Cushing's Syndrome

Cushing's syndrome occurs when the body is exposed to high levels of the hormone cortisol over a long period of time.

Sometimes Cushing's syndrome develops when people take certain hormones for asthma, rheumatoid arthritis, lupus, and other inflammatory diseases. The syndrome also can occur when hormones are taken to suppress the immune system so that a patient's body will not reject a transplanted organ.

Other people develop Cushing's syndrome because their bodies produce too much cortisol. Other causes of Cushing's syndrome include pituitary adenomas (a type of benign tumor), ectopic adrenocorticotropic hormone syndrome, adrenal tumors, or familial Cushing's syndrome. Cushing's syndrome due to tumors occurs more commonly in women.

Congenital Adrenal Hyperplasia (CAH)

CAH is a group of inherited disorders of the adrenal glands. It affects men and women equally. Both parents must carry the gene in order for a child to be born with CAH. Researchers have identified the location of the gene that causes the most common forms of CAH as chromosome 6.

Pituitary Tumors

Scientists have not yet discovered what causes pituitary tumors. Most pituitary tumors are not inherited; only a small percentage of cases run in families.

Pheochromocytoma/Paraganglioma

Most of the time, pheochromocytoma and paraganglioma tumors are "sporadic," meaning why they develop is not associated with any known risk factor or genetic mutation. However, research increasingly shows that a number of patients, possibly up to one-quarter, have genetic mutations responsible for tumor development. In these patients, family members may also be affected.

Addison's Disease

In all cases of Addison's disease, the adrenal glands do not produce enough of the hormone cortisol. In most cases, the glands also make too little of the hormone aldosterone. This is also termed primary adrenal insufficiency. This disease can be caused by an autoimmune disorder, infection (for example, tuberculosis), or other rare diseases that cause infiltration and thus destruction of the adrenal glands (for example, sarcoidosis or amyloidosis). The most common cause of Addison's disease in developed countries is autoimmune disorders.

Hyperaldosteronism

There are two causes of hyperaldosteronism. One cause is an excessive growth of normal cells in both adrenal glands. The other cause is a non-cancerous tumor in one of the glands. There are no known gene mutations associated with this disorder at this time. However, rarely, hyperaldosteronism can run in families.

Methods for diagnosing adrenal gland disorders differ depending on the specific disorder. For example, the severe form of congenital adrenal hyperplasia (CAH) is most commonly identified during newborn screening. But pheochromocytoma is diagnosed using blood and urine tests.

Adrenal Gland Tumors

To diagnose an adrenal gland tumor, a health care provider may order one or more tests.

• Blood and urine tests help measure the amount of adrenal hormones, which can detect a functional tumor.
• A computed tomography (CT or CAT) scan or a magnetic resonance imaging (MRI) scan may be useful in diagnosing an adrenal gland tumor and determining whether it is cancerous.
• A metaiodobenzylguanidine (MIBG) scan can detect a neuroendocrine tumor.
• An interventional radiologist can test the blood from the veins of each adrenal gland to identify tumors that CT or MRI scans can't pick up, or to determine if both glands have small masses (and thus both may require surgery).

Cushing's Syndrome

If a health care provider suspects that a patient has Cushing's syndrome, he or she may order one or more of the three screening tests currently in use for this disorder.

• One of the tests screens for elevated cortisol levels in saliva.
• Another test looks for elevated cortisol levels in the urine over 24 hours.
• A third test checks to see if a synthetic (man-made) steroid, called dexamethasone (pronounced dek-suh-METH-uh-sohn), reduces cortisol production by the body.

Congenital Adrenal Hyperplasia (CAH)

The most common way health care providers identify CAH in infants is through newborn screening. If the first screening test indicates that the infant may have CAH, the health care provider will order another blood test to confirm the diagnosis.

In some cases, female infants may have visible genital abnormalities that lead health care providers to suspect CAH as the cause. In these cases, health care providers will order an additional test to confirm the diagnosis. The milder form of CAH, when suspected, can also be diagnosed by the ACTH stimulation test (described below).

Pituitary Tumors

The first step in diagnosing pituitary tumors is a physical exam that includes checking neurologic responses, like reflexes and strength, and evaluation for signs of high hormone secretion, such as acne or unusual hair growth. A health care provider may also conduct a vision test to determine whether the growth of a pituitary tumor has affected sight or peripheral vision.

If results of this test lead the health care provider to suspect a pituitary tumor, he or she will order one or more tests of the patient's endocrine function.

To confirm the diagnosis, the health care provider may ask for a test of the patient's visual field (the area visible at a given instant without moving the eyes) or a magnetic resonance imaging scan of the patient's head.

Pheochromocytoma/Paraganglioma

If a health care provider suspects a pheochromocytoma/paraganglioma, he or she may administer a blood or urine test. The test measures the levels of:

• Catecholamines (pronounced kat-i-KOL-uh-meens), hormones that increase the heart rate, blood pressure, rate of breathing, and amount of energy available to the body
• Metanephrines (pronounced met-uh-NEF-reens), molecules produced from the body breaking down catecholamines

Addison's disease

Typically, a blood test to measure cortisol levels and levels of adrenocorticotropic hormone (ACTH) is used to diagnose Addison's disease. A health care provider may also use an ACTH stimulation test, an hour-long test during which a person receives a synthetic (man-made) version of ACTH through an intravenous (IV) line. The health care provider compares blood levels of various hormones from before and after the ACTH is given. If cortisol levels are low, the person could have adrenal insufficiency and Addison's disease.

Hyperaldosteronism

If a health care provider suspects hyperaldosteronism, he or she may order blood and urine tests to check for high levels of aldosterone and low levels of potassium.

The health care provider also may order a computed tomography (called a CT or "cat") scan to determine whether there is a non-cancerous tumor or other abnormal growth of the adrenal glands.

Health care providers use a variety of surgical and medical treatments for adrenal gland disorders. These include:

• Surgery to remove tumors in the adrenal gland or, when appropriate, surgery to remove the one or both of the adrenal glands
• Minimally invasive surgery performed through the nostrils to remove tumors in the pituitary gland
• Medication to stop the excess production of hormones
• Hormone replacement

Cushing's Syndrome

The treatment for Cushing's syndrome depends on the cause. If medication causes the excess cortisol, a health care provider can change the patient's dosage or try a different medication to correct the problem. If the Cushing's syndrome is caused by the body making too much cortisol, treatments may include oral medication, surgery, radiation, or a combination of these treatments.

Congenital Adrenal Hyperplasia (CAH)

CAH cannot be cured, but it can be treated and controlled. People with CAH can take medication to help replace the hormones their bodies are not making. Some people with CAH need only these medications when they are sick, but other people with CAH may need to take medication every day.

Pituitary Tumors

The most widely used treatment for non-cancerous pituitary tumors is removal of the tumors. Using a microscope and small instruments, the health care provider removes the tumor through a nostril or opening below the upper lip. The process is called transsphenoidal adenomectomy (pronounced TRANS-sfee-NOY-dul a-dee-na-MEK-ta-me). Radiation is also used.

Pheochromocytoma/Paraganglioma

The usual treatment for pheochromocytoma/paraganglioma is removal of the tumor through surgery. In most cases, removing the tumor improves the patient's blood pressure control. This treatment seems to be more effective in patients whose high blood pressure is sporadic than in those patients whose high blood pressure is long lasting.

Addison's Disease

Addison's disease is treated by replacing the cortisol and/or aldosterone that the body is lacking. People with Addison's disease take medication (usually by mouth) each day to replace these hormones. They may also need to consume additional salt.

Hyperaldosteronism

The treatment for hyperaldosteronism depends on what is causing the disorder.

• For hyperaldosteronism caused by an excessive growth of normal cells in both adrenal glands, the treatment involves medications that block the effect of aldosterone.
• The treatment for hyperaldosteronism caused by a non-cancerous tumor in one adrenal gland is removing the affected gland using laparoscopic (pronounced la-puh-re-SKOP-ic) surgery. This type of surgery is minimally invasive, involving only small incisions in the abdomen, and is usually easier to recover from than traditional surgery.