Adrenal dysfunction

What is it?

The adrenal glands are highly complex glands located above the kidneys and produce a large number of hormones that can be divided into two different classes: catecholamines (adrenaline, noradrenaline and dopamine), produced by the innermost part of the gland, called the medulla, and hormones produced by the cortical, outermost part of the adrenal gland, including cortisol, aldosterone and androgens. The hormones produced are involved in regulating various processes in the human body, such as controlling blood pressure, maintaining sodium and potassium levels in the blood, controlling heart rate and the ability to respond to stressful situations.

Which are the symptoms?

Diseases primarily affecting the adrenal glands can be tumourous, cystic, enzymatic or inflammatory in nature. The adrenal gland interacts with many other glands, particularly the pituitary gland, which is responsible for its control with adenocorticotropic hormone (ACTH). Some types of dysfunction can therefore be the result of dysfunction of the pituitary gland affecting adrenal function.

The main diseases of the adrenal glands are as follows:

·         Diseases associated with tumours

·         Cushing's syndrome

·         Conn's syndrome

·         Pheochromocytoma

·         Cysts

·         Enzyme dysfunction

·         Inflammatory diseases

How is it diagnosed?

If adrenal pathology is suspected, it is advisable to consult an endocrinologist, who can prescribe targeted laboratory tests (hormone tests and analyses) to help make the diagnosis. If initial tests indicate the presence of endocrine disorders, further investigations can be carried out using various diagnostic methods such as CT scans, nuclear magnetic resonance and nuclear medicine techniques. If necessary, dynamic hormonal tests can be carried out to assess the second level (tests are carried out in a day hospital).

Suggested exams

How is it treated?

The treatment of adrenal dysfunction varies according to the underlying clinical condition. In particular:

  • neoplastic disease can be managed based on a number of criteria, including size, radiological features, secretory activity, and growth of the lesion; therefore, surgical and/or drug treatment or active surveillance may be indicated; malignant tumours can be treated with chemotherapeutic drugs 
  • in primary adrenal insufficiency, glucocorticoid and mineralocorticoid replacement therapy is indicated;
  • in cystic disease, surgical intervention is generally indicated, but active surveillance may also be recommended based on certain criteria;
  • inflammatory diseases involving the adrenal glands may include different treatments, including immunomodulatory therapy.

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