Overactive Adrenal Glands

Aldosteronoma

Cushing's Syndrome

What are overactive adrenal glands?

When adrenal glands produce excessive amounts of certain hormones, they are called "overactive." Symptoms and treatment depend on which hormones are being overproduced:

• androgenic steroids (androgen hormones) - an overproduction of androgenic steroids (such as testosterone) can lead to exaggerated male characteristics in both men and women, such as hairiness of the face and body, baldness, acne, deeper voice, and more muscularity.

• corticosteroids - an overproduction of corticosteroids can lead to Cushing's syndrome (see below).

• aldosterone - an overproduction of the aldosterone hormone can lead to high blood pressure and to those symptoms associated with low levels of potassium such as weakness, muscle aches, spasms, and sometimes paralysis (see below).

The symptoms of overactive adrenal glands may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How are overactive adrenal glands diagnosed?

• specific blood tests to measure levels of hormones
• urine tests to measure levels of hormones

Treatment of overactive adrenal glands:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include surgical removal of growths or the adrenal gland(s) itself. Certain drugs that block the excessive production of certain hormones may also be administered.

What is an aldosteronoma?

An aldosteronoma is a benign tumor of the adrenal that over-secretes aldosterone. This adrenal cortex hormone plays an important role in regulating the body’s salt, potassium, and fluid balance. 

What are the symptoms of an aldosteronoma?

The association of high blood pressure, low potassium, and an aldosterone producing adenoma was first described by Dr. Jerome W. Conn. Patients with symptoms of aldosterone over-production caused by a tumor in the adrenal cortex (an adenoma) have Conn’s syndrome. This syndrome is characterized by high blood pressure, low potassium, tiredness, muscle weakness, and passing of large volumes of urine particularly at night (nocturia). Aldosteronomas are usually small (<1 inch) yellow tumors that occur most frequently in middle-aged adults. 

How is an aldosteronoma diagnosed?

The usual screening test is to measure the serum potassium level. If it is low, diagnostic tests are done including measuring blood and urinary aldosterone levels and blood renin levels. In Conn’s syndrome, the aldosterone is elevated and the renin is suppressed. If these tests are diagnostic, then imaging studies are done to see if a tumor can be localized.

Since these tumors are small they can be hard to find even with the best CT or MRI scan. Some patients may have no obvious radiographic tumor but one adrenal is affected (unilateral primary adrenal hyperplasia) and they can benefit from surgical removal. Other patients may have both adrenals affected with no visible tumor (idiopathic hyperaldosteronism) and surgery will not help. In these situations blood has to be drawn from each adrenal vein (so called adrenal venous sampling) in order to measure aldosterone levels to be sure which adrenal has the tumor. The symptoms of hyperaldosteronism may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

To summarize: In addition to a complete medical history and physical examination, the diagnostic procedures for aldosteronoma may include:

Blood and urine tests - to measure potassium and hormone levels.

Computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI) – are non-invasive procedures that take cross-sectional images of the adrenal or other internal organs to detect any abnormalities that may not show up on an ordinary x-ray.

Adrenal venous sampling- is an invasive test performed by a radiologist where a catheter is placed in the adrenal veins to measure the hormone level and confirm the tumor location. 

Treatment for aldosteronomas:

When the condition has been diagnosed and the tumor has been localized, it is treated by removal of the adrenal gland. This is best done with a laparoscopic adrenalectomy. Almost all patients will no longer have problems with low potassium after they have had their tumor removed. More than half of the patients will have improvement of their blood pressure so they do not have to take any medicine at all. Another quarter to a third will be improved but still have to take some medicine for their blood pressure.

What is Cushing’s syndrome?

Cushing’s syndrome is a rare disorder that has a prevalence of 10 patients per 100 million population per year. It can be classified into pituitary dependent or ACTH dependent Cushing’s syndrome, which is also known as Cushing’s disease. Most patients with Cushing’s syndrome will have this problem. However 10 or 15 percent of patients will have a tumor in the adrenal gland and another 10 or 15 percent will have a tumor outside of the adrenal gland that is making adrenocorticotrophic hormone or ACTH. These latter patients have what is known as ectopic ACTH syndrome.

Cushing’s syndrome is due to excess cortisol secretion. It causes characteristic symptoms including obesity of the trunk and thinning of the extremities, a thickening at the base of neck called a buffalo hump, a rounding of the face, weakness of the proximal muscles, thinning of the skin, hirsutism or an increase in hair, easy bruisability, depression, osteoporosis, high blood pressure, and glucose intolerance or diabetes. Cortisol has widespread effects on metabolism and organ function and prolonged exposure can be detrimental to the body. The symptoms of hypercortisolism may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is Cushing’s syndrome diagnosed and treated?

The various causes of Cushing’s syndrome can be sorted out by doing blood tests and radiologic images of the adrenal gland. This is important because tumors in the adrenal gland causing Cushing’s syndrome are best treated by removal. Ectopic ACTH tumors are also best treated by removal. Cushing’s disease or pituitary dependent Cushing’s syndrome is usually treated by removing a small microscopic tumor from the pituitary gland. Removing both adrenal glands will completely reverse this problem of Cushing’s disease and is done when a rapid reversal of the patient’s symptoms is needed. The best way to remove the adrenal glands and their tumors are laparoscopic adrenalectomy. This can be done safely if there is no risk of cancer.

In addition to a complete medical history and physical examination, diagnostic procedures for a cortisol producing tumor may include:

Blood and urine tests to measure hormone levels

Computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI) -are non-invasive procedures that take cross-sectional images of the adrenal or other internal organs to detect any abnormalities that may not show up on an ordinary x-ray.

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