When the adrenal glands are disturbed, too much or too little hormone is produced – this results in over- or under-functioning of various organs with a variety of clinical pictures.
Hyperfunction of the adrenal cortex
When the adrenal cortex produces too much aldosterone, it leads to Conn’s disease (also known as hyperaldosteronism). Symptoms of Conn’s disease are:
- Hypertension
- Potassium deficiency
- Constipation
- Muscle weakness
- Great thirst
- Frequent urination
The cause may be a benign tumor in the adrenal cortex (Conn adenoma). The tumor is usually removed, possibly additional medication is given.
Cushing’s syndrome
Overproduction of cortisol causes the clinical picture of hyperadrenocorticism. If the cause is directly in the adrenal cortex, for example a tumor, the condition is called Cushing’s disease.
A tumor in the pituitary gland or other malignant tumors such as lung cancer, on the other hand, cause Cushing’s syndrome. Typical external symptoms are:
- A round, large face
- Thin arms and legs
- Strong fat accumulation in the abdomen and neck (= truncal obesity).
- Red stripes on the skin (striae rubrae)
In addition, there are disorders of sugar metabolism, in some cases diabetes, and the breakdown of bone and muscle tissue.
If the tumor can not be removed, the overproduction of cortisol is inhibited with medication. Incidentally, long-term high-dose treatment with anti-inflammatory drugs containing glucocorticosteroids such as prednisolone or dexamethasone produces symptoms similar to those of Cushing’s disease as side effects – which is why many people are afraid of taking cortisone, although this is unfounded at current dosages.
Masculinization and feminization.
Sometimes there are androgen- or estrogen-producing, usually malignant tumors in the adrenal cortex. The incorrect hormone production leads to “masculinization” of the sexual characteristics in women (for example, absence of menstruation, beard growth) and correspondingly to “feminization” in men (including shrinkage of the testicles, growth of the mammary glands). These tumors are surgically removed.
Hypofunction of the adrenal cortex
When the adrenal cortex makes too little cortisol, the condition is called adrenal insufficiency.
In primary adrenal insufficiency (Addison’s disease), the cause lies directly in the adrenal cortex: it is often an autoimmune disease, but a tumor or an infectious disease such as tuberculosis can also destroy the hormone-producing cells of the adrenal cortex.
In the secondary form, the cause is hypofunction of the hypothalamus or pituitary gland. Tumors, inflammations, radiation treatments or circulatory disorders impair their hormone production. As a result, the hormonal control loop is disturbed and the adrenal cortex produces no or too little cortisol. In addition to low blood pressure and fatigue, listlessness, loss of appetite, and weight loss occur.
In Addison’s disease, the skin (especially on the nipples), the nail bed, and even fresh scars have a darker color than normal. People with a disorder of the pituitary gland tend to be noticed for their particularly pale skin.
In many people, the disease is initially inconspicuous; only in a stressful situation does a so-called Addison’s crisis occur: the lack of cortisol leads to a drop in blood pressure, shock, vomiting and diarrhea. Adrenocortical insufficiency is treated with cortisol and mineral corticoids by medication.