The adrenal glands are endocrine glands sitting on top of the kidneys on both sides of the abdomen within a space of the abdomen called the retroperitoneum. They are glands that secrete some very important hormones. Some of the main hormones are described below:
- Catecholamines (Epinephrine/Norepinephrine) - Epinephrine is known as adrenaline in lay-persons terms. These hormones are released from the central portion of the adrenal gland called the medulla. They are responsible for inducing the "flight or fight" response in times of stress. Specifically, they work to increase your heart rate, blood pressure and metabolism.
- Mineralcorticoids (Aldosterone) - Aldosterone is a hormone released from the cortex (zona glomerulosa), or outer covering, of the adrenal gland. This hormone is produced and released in response to low blood pressure sensed by the kidneys. It works on the kidneys to reabsorb more sodium and water back into your system, in effect increasing your blood pressure.
- Glucocorticoids (Cortisol) - Cortisol is also a hormone released by the cortex (zona fasciculata) of the adrenal gland. This is an important hormone that acts to mobilize fats, proteins and carbohydrates for use in energy production. It also improves the function of other hormones.
- Androgens (DHEA/Testosterone) - known as male sex hormones. Secreted from the cortex (zona reticularis)
Abnormalities occur in the adrenal glands when solitary tumors develop in one of these areas. Commonly the tumors are encountered incidentally when people undergo CT or MRI scans of the abdomen for other reasons. However, sometimes people will present with excessive hormone release of one of the above hormones as a result of a tumor. Most tumors of the adrenal gland are not biologically active. When they are people may present with the following symtpoms:
- Excessive catecholamines from a pheochromocytoma results in episodic hypertensive episodes with excessive sweating, headaches, palpitations and severely elevated blood pressures. This can cause severe or life-threatening injury to other organs and must be treated. People are usually started on medications right away to control the blood pressure swings. Eventually surgery is recommended
- Excessive aldosterone from an aldosteronoma results in long-standing hypertension along with low potassium levels. These tumors tend to be small and must be differentiated from a diffuse disease process that involves both glands and is not surgically corrected called bilateral adrenal hyperplasia. Once confirmed in location and size we recommend surgical removal of the gland to cure the hypertension and low potassium levels.
- Excessive cortisol producing tumor is also known as Cushing's syndrome. People with this problem will have central body obesity, glucose intolerance/elevations, high blood pressure, excessive hair growth, osteoporosis (bone loss). Excessive cortisol release from the adrenal glands can happen as a result of other abnormalities. Once there is confirmation that it is coming from a solitary mass in the adrenal gland itself surgical resection is recommended. This is usually done with various blood/urine tests and imaging such as a CT scan. Post-operatively people may need to be on a steroid taper to allow time for the other adrenal gland to "wake up" and resume cortisol production as it may have been suppressed previously.
Surgery is recommended if you have a tumor that is functional or a non-functional tumor that is suspicious for adrenal cortical carcinoma (adrenal cancer). This is determined by the size, growth and imaging characteristics of a mass seen on the adrenal gland. Cancer of the adrenal gland is rare but is difficult to prove without pathologic confirmation. It is rare that only the mass is removed without removing the entire gland as recurrence can be a problem. Also, it is rare that both adrenal glands are removed. If surgery is recommended resection of the adrenal gland is commonly done laparoscopically. This involves between 3 to 4 small incisions within the abdomen to remove the adrenal gland with the tumor. People will usually stay in the hospital up to 2-3 nights. Modifications to blood pressure medications or cortisol/steroid medications depend on how people do post-operatively.
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