The adrenal glands sit atop the kidneys.

The adrenal glands sit atop the kidneys. (Photo credit: Wikipedia)

Addison’s Disease

Addison’s disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone. This disease is also called adrenal insufficiency, hypoadrenia (“hypo”=low and “ism” =condition of) or hypocortisolism.
According to the National Institutes of Health:
Addison’s disease affects about 1 in 100,000 people;
• Adrenal insufficiency occurs when at least 90 percent of the adrenal cortex has been destroyed and no cortisol is being produced.
Symptom of Addison’s Disease
The more common symptoms of Addison’s Disease are:
• Weight loss
• Muscle weakness
• Fatigue
• Low blood pressure
• Dark or patchy skin
• Salt craving
• Dizziness
• Nausea
• Depression

 Addison’s Disease Tests

Two of the common tests used to diagnose Addison’s disease are:
• ACTH Stimulation Test.  The ACTH Test usually measures the levels of blood cortisol, urine cortisol before and after a synthetic form of ACTH is given by injection.  If the adrenals are functioning properly, there is an increase in blood and urine cortisol levels and the amount of the increase tells doctors about the extent of the adrenal problem.
• CRH Stimulation Test. If the ACTH test is abnormal, a CRH (cortisol releasing hormone from the hypothalamus) stimulation test is used to determine the cause of adrenal insufficiency.  Synthetic CRH is injected intravenously and blood cortisol is measured before and 30, 60, 90, and 120 minutes after the injection. If there is no ACTH response, this indicates the problem may be the pituitary gland.  If there is a delayed ACTH response, the hypothalamus may be the cause.

Addison’s Disease Treatment

If cortisol is low, then oral synthetic glucocorticoid is given to increase the amount of cortisol.  If aldosterone is low, then synthetic aldosterone is given.

Cushing’s Syndrome

In the 1930‘s, Dr. Harvey Cushing  observed that patients with high cortisol often suffered from obesity, glucose intolerance, hypertension, excess hair growth, osteoporosis, kidney stones, menstrual irregularity, and emotional problems.  Cushing’s syndrome or hypercortisolism (“hyper”=high and “ism” =condition of) is often diagnosed when there is a high level of cortisol for a long period of time.   According to the National Institutes of Health, Cushing’s syndrome is relatively rare and most commonly affects:
• Adults aged 20 to 50;
• People who are obese and have type 2 diabetes.
Because of the dangerous effects of elevated cortisol levels, people who take prednisone (a synthetic form of cortisone that is used in the treatment of rheumatoid arthritis and other inflammatory diseases) or any other form of cortisol should carefully monitor their cortisol levels.

Symptoms of Cushing’s Syndrome

People with Cushing’s syndrome often experience one or more of these symptoms:
• Upper body obesity (above the waist) and thin arms and legs
• Round, red, full face
• Slower than normal growth rate in children
• Acne or other skin infections
• Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts
• Easy skin bruising
• Backache, which occurs with routine activities
• Tenderness or pain felt in the bones
Fat between the shoulders often likened to a hump
• Easily fractured ribs or other bones
• Muscle weakness
• Excess hair growth on the face, neck, chest, abdomen, and thighs
• Menstrual problems
• Decreased or no desire for sex
• Impotence
• Depression, anxiety, or changes in behavior
• Fatigue
• Headaches
• Increased thirst and urination

Cushing’s Syndrome Tests

Some of the common tests used to diagnose Cushing’s syndrome are:
• 24-hour urinary free cortisol test where urine is collected over a 24 hour period and tested for cortisol;
• Measurement of midnight plasma cortisol using blood tests to show the level of cortisol at night (when it should be lower at midnight)   .
• Late-night salivary cortisol where a saliva test is used to determine the level of cortisol at night;
• Giving high or low doses of synthetic cortisol and then checking the urine to see if there is a drop in blood and urine cortisol levels;
• CRH stimulation test described above.

Cushing’s Syndrome Treatment

While the treatment will depend on the cause for the high cortisol levels, some of the traditional options are:
• Surgery;
• Radiation
• Chemotherapy;
Cortisol-inhibiting drugs.