Adrenal Disorders

The outer region of the adrenal gland is called the cortex, and the inner region, the medulla. They contain highly specialised cells that secrete distinct hormones, with different functions.

Adrenal Cortex – secretes 3 types of hormones:

1. Glucocorticoids – Control inflammation and regulate the body’s response to infections and stress. Helps in maintaining blood pressure, blood sugar and cardiovascular function.
2. Mineralocorticoids – Regulate sodium and potassium levels in the body, and helps maintain blood pressure and water balance, via the kidneys.
3. Adrenal Androgens – DHEA, which are precursors of the sex hormones testosterone and oestrogen. Adrenal glands also produce a small amount of testosterone.

Adrenal medulla – Produces catecholamine hormones – adrenaline, noradrenaline and dopamine.

• They are responsible for the “flight or fight” response to stress or fear, as increased heart rate and blood pressure, rapid breathing and more blood flow to muscles. This reaction is through the sympathetic nervous system that controls breathing, heart rate and the metabolism.
• The Hypothalamus directs the pituitary gland to release adrenocorticotropic hormone that regulate the production and secretion of hormones from the adrenal cortex.
• Normally the secretion of hypothalamic, pituitary, and adrenal cortex hormones are finely controlled by the other glands.
• Chronic stress and disease conditions may make this system imbalanced.

Impaired Adrenal Function could lead to the increased or decreased production of adrenal hormones, resulting in one of two conditions:

1. Cushing’s Syndrome:

• Blood levels of cortisol are high and stay like that for a long period of time, causing characteristic changes in the body.
• These changes are rounded “moon” face, gaining weight around the trunk, slender arms and legs. Skin is often thin and has a bruised appearance with stretch marks.
• This could also include muscle weakness, risk of infection, and high blood sugar levels, weak bones, as well as mood disorders, like anxiety and depression.
• Children with excess cortisol can lead to stunted growth.
• Men have an reduced libido and fertility
• Woman can have abnormal hair growth on face, neck, thighs and chest, as well as menstrual disorders.
• Excess secretion of adrenal androgens could lead to the presence of external male characteristics in females or in boys before puberty.

2. Addison’s disease

• Uncommon, debilitating disease, rarely identified in its early stages.
• The function of the adrenal cortex declines over time, and results in glucocorticoid and mineralocorticoid deficiency, and reduced levels of DHEA and androgens.
• Symptoms are weakness, low blood pressure and fatigue, often people have heavy pigmentation on the skin around bony prominences, skin folds, and the back of arms and legs, a blueish discolouration of the mucus membrane lining in the mouth.
• Cortisol and aldosterone deficiency can cause changes in blood levels of sodium and potassium and decrease plasma volumes that can lead to extreme dehydration and shock.
• Trauma, surgery and infections in people with reduced adrenal function could have adrenal crisis – life threatening condition, and have extreme weakness, severe body pain, low blood pressure and fever.

Adrenal fatigue is a condition which shares symptoms with Addison’s disease. These include tiredness, depression, muscle pain, poor concentration, low blood sugar, craving for stimulants, and difficulty sleeping.

This makes it unable for the adrenal glands to work normally due to the chronic stress exposure.

There are a variety of risk factors for both Addison's disease and Cushing's syndrome.

• The condition is diagnosed based on an assessment of clinical signs and symptoms.
• Lab tests are done to assess the electrolyte levels in the blood and the serum levels of cortisol and ACTH.
• CT scans of the adrenal or pituitary glands are performed.
• Low serum cortisol and increased serum ACTH levels, are indications for Addison’s disease.
• Cortisol levels vary to the time of day, and peaks in the morning around 8AM.
• When these levels are decreased Addison’s disease is diagnosed.
• These individuals also do not show an increase of serum cortisol levels when injection of cosyntropin are given.
• When fasting, patients could develop very low glucose levels in the blood, as they are unable to produce glucose from stored fat and proteins.
• Abnormally low blood levels of DHEA sulphate and decreased cortisol and aldosterone levels are indicative of adrenal insufficiency.

• Characteristics are diagnostic and are confirmed via lab test results.
• People have increased levels of cortisol in their urine
• ACTH levels are measured as it help to distinguish between 2 types of Cushing’s syndrome.
• MRI and CT scans are useful for diagnosing pituitary and adrenal tumours.

There are a variety of treatments for both Addison's disease and Cushing's syndrome.

Stem cells: The adrenal cortex contains dormant adrenal stem cells that can multiply and differentiate and replenish all cell types that make up the adrenal gland.

Pasireotide: Shows results in reducing cortisol levels in Cushing’s disease. It is suggested as a therapeutic target for pituitary-dependant Cushing’s disease.

• Avoid carbohydrates – Simple carbohydrates are metabolised and absorbed faster by the body. This fast absorption triggers a quick spike in blood glucose levels that decline fast as insulin levels rise.
• Diet properly – Chronic stress is related to increase in cortisol levels, that promote overeating and increases in abdominal fat. When dieting blood levels of leptin decrease, and notifies the brain that there is a decreased energy storage. The brain then reacts by increasing appetite and decreasing metabolism – “Yo-Yo dieting”
• Limit stimulants – Energy drinks and caffeine increase cortisol production, and should be consumed in moderation.
• Exercising – Stimulates the production of cortisol and other glucocorticoids from the adrenals.
• Maintaining a positive outlook and good self-esteem – By doing this you can lower the stress hormone levels
• Sleep – Sleep deprivation is the cause for high cortisol levels. Disturbed sleep, over activity of the HPA axis, metabolic disturbances, insomnia and depression are observed in people with Cushing’s syndrome.

1. Melatonin:

Plays a role in inducing sleep and regulating the circadian rhythm. Cushing’s syndrome shows low levels of melatonin, as well as a disruption of its circadian secretion. This shows that it has a direct effect on the adrenal glands.

2. Vitamin D & Calcium

Vitamin D supports calcium absorption and lack thereof can cause osteoporosis. In Cushing’s syndrome high cortisol levels lead to osteoporosis. Vitamin D supplements are useful in people with this syndrome who have high cortisol levels, and in Addison’s disease where long-term hormone replacement is necessary.

3. Potassium

These levels are low in people with Cushing’s syndrome, which are a significant risk for cardiovascular complications. Potassium supplements could be useful to use with this syndrome

Vitamin A & Curcumin Supplementation

• Liquorice
• Known to regulate the HPA axis.
• Increases levels of DHEA and testosterone.
• Useful for androgen deficiency in adrenal disorders, and increases cortisol levels.

• DHEA
• Supplementation has shown to improve regulation of inflammation and immune response, giving a better quality of life.

• Vitamin B5
• Used to maintain normal adrenal structure and function, thus improving adrenal function. Vitamin B5 can modulate cortisol secretion in response to stress.

• Coenzyme Q10
• It’s absorbed better into the bloodstream. Adrenal hormone secretion is related to coenzyme q10 levels. People with an irregular pituitary-adrenal axis function have low Q10 levels, compared to people with adrenal hyperplasia or multiple pituitary deficiencies.