What Causes Adrenal Gland Problems And Disorders?

Adrenal gland problems and disorders start when the two small glands sitting on top of your kidneys make too much or too little of certain hormones. These hormones control blood pressure, metabolism, stress response, and salt and water balance. When the glands malfunction, the effects ripple through your whole body. The most common causes include autoimmune disease, tumors, infections, and genetic conditions, though the specific cause depends on whether the gland is overproducing or underproducing hormones.

What Do the Adrenal Glands Actually Do?

Each adrenal gland has two distinct parts, and each part makes different hormones. The outer layer, called the cortex, produces cortisol, aldosterone, and androgens. The inner part, called the medulla, produces adrenaline and noradrenaline.

Cortisol helps manage stress, blood sugar, and inflammation. Aldosterone tells your kidneys how much salt and water to hold onto, which directly controls blood pressure. Adrenaline is the fast-acting “fight or flight” hormone. When any of these are out of balance, you get specific symptoms based on which hormone is affected.

Most adrenal disorders fall into one of two categories: the gland produces too much hormone or too little. The causes for each category are different.

What Causes Adrenal Gland Problems And Disorders?

The cause depends on the specific disorder. Primary adrenal insufficiency, also called Addison’s disease, happens when the adrenal glands themselves fail. In developed countries, about 70% of cases are caused by an autoimmune reaction where the immune system attacks the adrenal cortex. The rest come from infections like tuberculosis, bleeding into the glands, or cancer that has spread to the adrenals.

Cushing’s syndrome is the opposite problem — too much cortisol. The most common cause is taking corticosteroid medications like prednisone for long periods. When Cushing’s syndrome is not medication-related, a pituitary tumor that signals the adrenals to overproduce cortisol is usually responsible. Less often, a tumor directly on the adrenal gland causes the overproduction.

Conn’s syndrome, also called primary aldosteronism, happens when one or both adrenal glands produce too much aldosterone. A benign tumor on the adrenal gland causes most cases. High aldosterone makes the kidneys hold onto salt, which drives blood pressure up and can be resistant to usual blood pressure medications.

Pheochromocytoma is a rare tumor of the adrenal medulla that releases excess adrenaline. Most of these tumors are benign, but they cause dangerous spikes in blood pressure and heart rate. About 25% of pheochromocytomas are linked to inherited genetic mutations.

In many cases, the exact cause is never fully identified. Adrenal insufficiency can also result from the pituitary gland failing to signal the adrenals, which is called secondary adrenal insufficiency. This is most often caused by pituitary tumors, head trauma, or sudden withdrawal from long-term steroid use.

How Do You Know If Your Adrenal Glands Are Not Working Right?

Symptoms vary widely depending on which hormone is affected and whether there is too much or too little of it.

Adrenal insufficiency (too little cortisol and aldosterone) typically causes profound fatigue, unintentional weight loss, low blood pressure, salt cravings, and darkening of the skin in the creases and scars. Nausea, vomiting, and abdominal pain are also common. These symptoms develop slowly, sometimes over months, and are often mistaken for other conditions.

Cushing’s syndrome (too much cortisol) causes weight gain concentrated in the face, neck, and abdomen, thinning skin that bruises easily, purple stretch marks, muscle weakness, and high blood sugar. Women often notice irregular periods and excess facial hair.

Primary aldosteronism (too much aldosterone) usually produces no symptoms at all until high blood pressure is discovered. Some people experience headaches, muscle weakness, or frequent urination because the kidneys are excreting too much potassium.

Pheochromocytoma causes episodic headaches, sweating, and a racing heart. Blood pressure can spike dramatically during these episodes. Some people experience anxiety or panic attacks because the physical symptoms feel identical.

None of these symptoms alone confirms an adrenal disorder. Blood tests measuring cortisol, aldosterone, and adrenaline levels are needed for diagnosis. An ACTH stimulation test is the standard way to check if the adrenal glands respond properly to stimulation.

Can Stress Cause Adrenal Gland Problems?

No. Everyday stress does not damage the adrenal glands or cause adrenal disorders. This is a widespread myth promoted by wellness marketing.

The term “adrenal fatigue” has been used to explain chronic tiredness, brain fog, and sleep problems. No scientific evidence supports this condition. The Endocrine Society, the largest professional organization for hormone specialists, has explicitly stated that adrenal fatigue is not a real medical diagnosis. The adrenal glands do not “burn out” from stress.

Chronic stress does affect your body in real ways, including raising cortisol levels over time. But this is not the same as adrenal gland failure. If you feel persistently exhausted, the cause is more likely to be sleep deprivation, depression, thyroid disease, anemia, or another medical condition. These are all treatable, and a doctor can help identify the actual cause.

That said, a genuine medical emergency called adrenal crisis can occur when someone with known adrenal insufficiency experiences severe stress. Surgery, infection, or injury can trigger a dangerous drop in cortisol. This is managed with immediate steroid replacement and is a different situation entirely from everyday stress.

How Are Adrenal Disorders Treated?

Treatment depends entirely on the specific disorder.

Adrenal insufficiency is treated with hormone replacement. Hydrocortisone or prednisone replaces cortisol, and fludrocortisone replaces aldosterone. Most people take these medications daily for life. With proper dosing, people with Addison’s disease can live normal, active lives. The main risk is adrenal crisis, which requires emergency treatment with injectable steroids.

Cushing’s syndrome treatment focuses on the cause. If medications caused it, the dose is slowly reduced under medical supervision. If a tumor is responsible, surgery to remove it is usually the first choice. Radiation and medications that block cortisol production are options when surgery is not possible.

Primary aldosteronism is treated with surgery when a single tumor is found. When both glands are overactive or surgery is not an option, a medication called spironolactone blocks aldosterone’s effects and controls blood pressure.

Pheochromocytoma is treated with surgery to remove the tumor. Before surgery, medications are given to block the effects of excess adrenaline and prevent dangerous blood pressure spikes during the operation.

No over-the-counter supplement has been shown to treat any adrenal disorder. Supplements marketed for “adrenal support” are not backed by clinical evidence and can be harmful if they interfere with hormone levels. Always work with an endocrinologist for any suspected adrenal condition.

Who Is Most at Risk for Adrenal Disorders?

Autoimmune adrenal insufficiency is more common in women than men and most often appears between ages 30 and 50. People with other autoimmune conditions, such as type 1 diabetes or thyroid disease, have a higher risk.

Long-term use of corticosteroid medications is the most common risk factor for Cushing’s syndrome. These medications are prescribed for asthma, rheumatoid arthritis, inflammatory bowel disease, and many other conditions. The risk increases with higher doses and longer duration of use.

Genetic mutations play a role in some adrenal tumors. Anyone with a family history of pheochromocytoma or certain inherited conditions should discuss screening with their doctor. Most adrenal tumors, however, occur without any known family link.

If you are taking steroids for any condition, do not stop suddenly. Sudden withdrawal can cause adrenal insufficiency because your glands have stopped producing cortisol on their own. Your doctor will give you a tapering schedule to allow your adrenal glands to recover.