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Adrenal Disorder Specialist
Adrenal disorders are conditions that affect the adrenal glands, two small glands located above each kidney. These glands produce several hormones, including cortisol, aldosterone, and adrenaline, which regulate metabolism, immune system response, blood pressure, and the body’s response to stress.
When the adrenal glands produce too much or too little of these hormones, it can lead to health issues.
Dr Daphne Lee
MBBS
MRCP(UK)
FAMS
Types of Adrenal Disorders
Adrenal disorders encompass a range of conditions affecting the adrenal glands.
Adrenal Insufficiency
This condition occurs when the adrenal glands do not produce sufficient hormones, particularly cortisol and aldosterone. It can result from autoimmune diseases e.g. Addison’s disease, infections, or genetic factors.
Cushing's Syndrome
Characterised by excessive cortisol production, Cushing's syndrome can be caused by adrenal tumours or as a side effect of corticosteroid medications. It leads to a range of symptoms, including weight gain, hypertension, and skin changes.
Primary Aldosteronism (Conn's Syndrome)
This disorder involves the overproduction of aldosterone, leading to high blood pressure and low potassium levels.
Adrenal Cancer
Although rare, adrenal cancers like adrenocortical carcinoma can lead to excess hormone production or may be non-functional.
Pheochromocytoma
This tumour arises from adrenal gland cells that produce adrenaline. It causes episodes of high blood pressure, palpitations, and headaches.
Congenital Adrenal Hyperplasia (CAH)
A group of inherited disorders affecting the adrenal glands. CAH leads to an imbalance in hormone production, often requiring lifelong management.
Symptoms
The symptoms of adrenal disorders can vary depending on the specific condition and the hormones involved.
- Fatigue: A general feeling of tiredness and lack of energy is common in conditions like Addison’s disease.
- Weight Changes: Unexplained weight gain, particularly around the abdomen and face, is common in those with Cushing’s syndrome. Weight loss may occur in those with Addison’s disease.
- Muscle Weakness: Muscle weakness and aches can be a symptom of both excessive and insufficient cortisol production.
- Changes in Skin Condition: Thin skin, easy bruising, and stretch marks may develop in Cushing’s syndrome.
- High or Low Blood Pressure: High blood pressure can be a symptom of conditions like primary aldosteronism and pheochromocytoma, while low blood pressure is often seen in Addison’s disease.
- Abnormal Menstrual Periods: Women with adrenal disorders may experience irregular or absent menstrual cycles.
- Sexual Dysfunction: Decreased libido and sexual dysfunction can occur, particularly in conditions affecting hormone levels.
Causes
Adrenal disorders arise from disruptions in the endocrine system, specifically affecting the adrenal glands located above the kidneys.
Genetic Predisposition
Certain adrenal disorders, such as congenital adrenal hyperplasia, are inherited. Genetic mutations can influence the development of the adrenal glands or the production of adrenal hormones.
Autoimmune Disorders
Conditions like Addison’s disease occur when the immune system mistakenly attacks the adrenal glands, impairing hormone production.
Tumours
Benign or malignant growths on the adrenal glands can alter hormone levels. These tumours may be primary, originating in the glands, or secondary, resulting from a malignancy elsewhere in the body.
Certain Infections
Certain infections, particularly tuberculosis, can damage the adrenal glands, leading to disorders.
Certain Medications and Treatments
Prolonged use of corticosteroids and specific medical procedures can impact adrenal gland function.
Complications
If left untreated or improperly managed, adrenal disorders can lead to complications, affecting multiple body systems.
Electrolyte Imbalance
Conditions like adrenal insufficiency and primary aldosteronism can lead to imbalances in electrolytes, such as sodium and potassium. Electrolytes are necessary for nerve and muscle function.
Osteoporosis
Excessive cortisol production, as seen in Cushing's syndrome, can weaken bones. This increases the risk of fractures.
Hypertension
Disorders like primary aldosteronism and pheochromocytoma can cause persistently high blood pressure, which is a risk factor for heart disease and stroke.
Adrenal Crisis
Particularly in Addison's disease, a sudden drop in cortisol can lead to an adrenal crisis, a life-threatening emergency characterised by severe vomiting, diarrhoea, pain, and loss of consciousness.
Psychological Effects
Hormonal imbalances can impact mental health, leading to conditions such as depression or anxiety.
Metabolic Syndrome
Cushing's syndrome can increase the risk of developing metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes.
Diagnosis
Diagnosing adrenal disorders involves a combination of clinical evaluation, laboratory tests, and imaging studies.
- Medical History and Physical Examination: Initially, a thorough medical history and physical examination are conducted to collect information on the symptoms, family history, and any predisposing factors.
- Blood Tests: These tests measure levels of adrenal hormones, including cortisol, aldosterone, and adrenocorticotropic hormone (ACTH). Abnormal levels can indicate an adrenal disorder.
- Urine Tests: 24-hour urine collection tests help assess the levels of hormones produced by the adrenal glands.
- Imaging Tests: CT scans or MRIs of the adrenal glands can identify abnormalities such as tumours or structural changes.
Treatment Options
Treatment of adrenal disorders involves a tailored approach based on the specific condition and individual patient needs.
Hormone Replacement Therapy
The deficient hormones can be replaced for conditions like Addison’s Disease and adrenal insufficiency. Synthetic cortisol (hydrocortisone) and aldosterone (fludrocortisone) are commonly used.
Medication to Control Hormone Production
In Cushing’s Syndrome and other conditions of excess hormone production, medications that suppress hormone secretion can be effective. These include ketoconazole, mitotane, or metyrapone.
Dr Daphne Lee
MBBS
MRCP(UK)
FAMS
Dr Daphne Lee has special interests in the comprehensive management & treatment of diabetes, adrenal and pituitary conditions.
Qualifications
- MBBS (National University of Singapore, Singapore) 2006
- MRCP (Royal College of Physicians, United Kingdom)
- Fellow, Academy of Medicine, Singapore (FAMS)
- Registered with Specialist Accreditation Board (SAB)
- Registered with Singapore Medical Council (SMC)
Before private practice, Dr Daphne Lee was a consultant endocrinologist at Khoo Teck Puat Hospital. During her time there, she also ran the pituitary and adrenal clinics.
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38 Irrawaddy Road, #07 - 63,
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Mount Elizabeth Novena Specialist Center
38 Irrawaddy Road, #07 - 63,
Singapore 329563
Gleneagles Medical Centre
6 Napier Road, #03 - 10,
Singapore 258499
Frequently Asked Questions (FAQ)
Can Exercise Help Manage Adrenal Disorders?
Regular, moderate exercise may help regulate stress hormones and improve physical strength. The type and intensity of exercise should be tailored to individual health conditions and discussed with an endocrinologist, as overexertion may adversely affect adrenal function.
Can Diet Help Treat Adrenal Disorders?
Nutritional strategies that maintain balanced blood sugar levels, provide adequate salt intake and ensure sufficient nutrients can be beneficial. Specific dietary recommendations should be based on the type of adrenal disorder and individual health needs, formulated in consultation with the endocrinologist.
How Long Do I Need to Take My Medication for Adrenal Disorders?
The duration of medication for adrenal disorders varies depending on the type and severity of the condition. For chronic conditions like Addison’s disease, lifelong medication may be necessary. In other cases, such as treatment following adrenal surgery, medication might be temporary. Regular consultations with an endocrinologist can help monitor the condition and adjust medication as needed.
Can Adrenal Disorders Be Completely Resolved?
The possibility of a cure for adrenal disorders depends on the specific condition. Some disorders, particularly those caused by tumours, may be resolved through surgical intervention. Many adrenal conditions are chronic and require ongoing management. Consult with our endocrinologist to receive personalised care to promptly and effectively treat your condition.
Can Adrenal Disorders Be Prevented?
Prevention of adrenal disorders largely depends on the underlying cause. Genetic and autoimmune conditions are not preventable, but early detection and treatment can manage symptoms and improve quality of life. For adrenal disorders linked to lifestyle factors, maintaining a healthy lifestyle may reduce risk. Regular medical check-ups can aid in the early detection and prevention of complications.