Adrenal Gland

Adrenal gland are located on top of both kidneys. Although they are often thought to be directly related to the kidneys, they actually have no direct connection other than their anatomical position. Since they are responsible for secreting essential hormones, adrenal glands have a vital role in human health.

Approximately 3 cm in size and weighing around 3 grams, the adrenal glands consist of two layers: the inner layer called the medulla and the outer layer called the cortex. Due to their location in the body, they are difficult to observe, and diseases or masses may develop without noticeable symptoms in early stages, making early diagnosis challenging.

What Are the Functions of the Adrenal Glands?

The inner layer, known as the medulla, secretes adrenaline (epinephrine) and noradrenaline (norepinephrine). The production of these hormones is regulated by the pituitary gland in the brain. These hormones increase heart rate and blood pressure and are released during physical or emotional stress.

The cortex layer of the adrenal gland has three main functional zones:

Zona Glomerulosa

Secretes aldosterone, a corticosteroid responsible for maintaining water and salt balance in the body.

Zona Fasciculata

Produces cortisol, which plays a critical role in meeting the body’s energy needs.

Zona Reticularis

Produces dehydroepiandrosterone (DHEA) and androstenedione, which are involved in the production of sex hormones.

Adrenal Gland Diseases

Like all organs, adrenal glands can develop various diseases. Common conditions include:

Cushing’s Syndrome

Caused by excessive cortisol production. Symptoms include fat accumulation on the back, menstrual irregularities, diabetes, excessive hair growth, facial redness and acne, purple stretch marks, and osteoporosis.

Conn’s Syndrome (Primary Hyperaldosteronism)

Caused by excessive aldosterone secretion. It can lead to difficult-to-control hypertension, muscle cramps, metabolic alkalosis, sodium and fluid retention, and hypokalemia.

Pheochromocytoma

A condition caused by excessive secretion of adrenaline and noradrenaline, often leading to high blood pressure.

Acromegaly

A chronic condition resulting from excessive growth hormone production, sometimes related to adrenal dysfunction.

Adrenal Adenomas

Benign tumors of the adrenal gland, seen in about 5% of the population. Most cases are asymptomatic and detected incidentally. If untreated, tumors may grow up to 4 cm, increasing the risk of malignancy. Symptoms may include fatigue, hypertension, headaches, dizziness, osteoporosis, weight gain, and excessive hair growth.

What Causes Adrenal Tumors?

The exact cause of tumors is often unknown. However, genetic factors and excessive hormone production are believed to play a role.

Adrenal Tumor Surgery

Before surgery, several tests are required:

• ECG
• Complete blood count
• Urinalysis
• Fasting blood glucose
• Liver function tests

Additional tests may be requested if necessary. Based on results, surgery is planned. The procedure is performed under general anesthesia, so the patient feels no pain. Mild postoperative pain may occur but is manageable with medication.

Recovery time depends on the surgical method. Open surgery requires longer recovery, while robotic surgery allows faster and more comfortable healing. Most patients recover within one month.

Adrenalectomy (removal of the adrenal gland) can be performed using:

• Open surgery
• Laparoscopic surgery
• Robotic surgery

The chosen method depends on tumor type, size, and relation to surrounding tissues.

Adrenal Tumor Treatment

Adrenal tumors cannot be treated with medication alone. Surgical removal is required. The remaining adrenal gland can take over the functions of the removed gland. In rare cases where both glands are removed, lifelong medication is necessary.

How Are Adrenal Gland Disorders Diagnosed?

MRI provides more detailed information than CT scans in evaluating adrenal masses. It helps determine the structure of the mass and its relationship with blood vessels. It can also differentiate between benign and malignant tumors and diagnose pheochromocytoma.

Other diagnostic methods include scintigraphy and fine needle aspiration biopsy (FNAB) under ultrasound or CT guidance. However, biopsy is not recommended in suspected pheochromocytoma due to the risk of hypertensive crisis.

For detailed evaluation, imaging and laboratory tests are essential in determining the appropriate treatment approach.