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'''Adrenal gland disorders''' (or diseases) are conditions that interfere with the normal functioning of the adrenal glands.<ref name="Grossman 2022 l049">{{cite web | last=Grossman | first=Ashley B. | title=Hormonal and Metabolic Disorders | website=Merck Manuals Consumer Version | date=May 2, 2022 |url=https://www.merckmanuals.com/en-ca/home/hormonal-and-metabolic-disorders/adrenal-gland-disorders/overview-of-the-adrenal-glands | access-date=February 9, 2024}}</ref> Your body produces too much or too little of one or more hormones when you have an [[adrenal gland]] dysfunction. The type of issue you have and the degree to which it affects your body's hormone levels determine the symptoms.<ref name="National Library of Medicine 2024 a320">{{cite web | title=Adrenal Gland Disorders | publisher=National Library of Medicine | date=January 19, 2024 |url=https://medlineplus.gov/adrenalglanddisorders.html | access-date=February 9, 2024}}</ref>
The [[adrenal gland]] produces hormones that affects growth, development and stress, and also helps to regulate kidney function. There are two parts of the [[Adrenal gland|adrenal glands]], the [[adrenal cortex]] and the [[adrenal medulla]]. The [[adrenal cortex]] produces [[mineralocorticoid]]s, which regulate salt and water balance within the body, [[glucocorticoid]]s (including [[cortisol]]) which have a wide number of roles within the body, and [[Adrenal cortex#Androgens|androgens]], hormones with testosterone-like function.<ref name="jhadrenal">[http://www.hopkinsmedicine.org/healthlibrary/conditions/endocrinology/adrenal_glands_85,P00399/ Adrenal Glands], Johns Hopkins Medicine Health Library.</ref> The [[adrenal medulla]] produces [[epinephrine]] (adrenaline) and [[norepinephrine]] (noradrenaline).<ref name="jhadrenal" />
== Tumors of the adrenal gland ==
=== Adrenal adenoma ===
{{Main|Adrenal adenoma}}
[[Adrenal adenoma]]s are benign tumors that start in the cortex of the [[adrenal gland]]. They fall into one of two categories: functional or non-secreting. [[Adenoma]]s that are nonfunctional or have modest levels of hormone secretion may not show any symptoms at all and may remain asymptomatic. But [[Adenoma|adenomas]] with high levels of hormones frequently show up with primary [[hyperaldosteronism]], [[Cushing's syndrome|Cushing syndrome]], or [[hyperandrogenism]] symptoms.<ref name="Mahmood Loughner Anastasopoulou 2023 f880">{{cite web | last=Mahmood | first=Ejaz | last2=Loughner | first2=Chelsea L. | last3=Anastasopoulou | first3=Catherine | title=Adrenal Adenoma | publisher=StatPearls Publishing | date=August 17, 2023 | pmid=30969728 |url=https://www.ncbi.nlm.nih.gov/books/NBK539906/ | access-date=February 9, 2024}}</ref>
=== Adrenocortical carcinoma ===
{{Main|Adrenocortical carcinoma}}
[[Adrenocortical carcinoma]], (ACC), is cancer that develops in the [[Adrenal gland|adrenal glands]]' cortex, or outer layer.<ref name="Cleveland Clinic medical professional 2017 v644">{{cite web | author=Cleveland Clinic medical professional | title=Adrenocortical Carcinoma: What Is It, Causes, Symptoms & Outlook | website=Cleveland Clinic | date=October 11, 2017 |url=https://my.clevelandclinic.org/health/diseases/6152-adrenocortical-carcinoma | access-date=February 9, 2024}}</ref> [[Adrenocortical carcinoma]] usually occurs randomly, independent of a genetic predisposition.<ref name="Johns Hopkins Medicine 2021 r484">{{cite web | title=Adrenocortical Carcinoma | website=Johns Hopkins Medicine | date=December 7, 2021 |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenocortical-carcinoma | access-date=February 9, 2024}}</ref> The majority of patients' primary complaints at first are indications and manifestations of excess hormones.<ref name="Allolio Fassnacht 2006 pp. 2027–2037">{{cite journal | last=Allolio | first=Bruno | last2=Fassnacht | first2=Martin | title=Adrenocortical Carcinoma: Clinical Update | journal=The Journal of Clinical Endocrinology & Metabolism | publisher=The Endocrine Society | volume=91 | issue=6 | date=June 1, 2006 | issn=0021-972X | doi=10.1210/jc.2005-2639 | pages=2027–2037}}</ref> Due to local tumor growth, some patients have vague symptoms such as flank or [[abdominal pain]], fullness in the abdomen, or early satiety.<ref name="Fassnacht Allolio 2009 pp. 273–289">{{cite journal | last=Fassnacht | first=Martin | last2=Allolio | first2=Bruno | title=Clinical management of adrenocortical carcinoma | journal=Best Practice & Research Clinical Endocrinology & Metabolism | publisher=Elsevier BV | volume=23 | issue=2 | year=2009 | issn=1521-690X | doi=10.1016/j.beem.2008.10.008 | pages=273–289}}</ref>
=== Adrenal incidentaloma ===
{{Main|Adrenal incidentaloma}}
An [[adrenal incidentaloma]] is a mass lesion larger than 1 cm in diameter that was unintentionally found through radiologic examination.<ref name="Young 2007 pp. 601–610">{{cite journal | last=Young | first=William F. | title=The Incidentally Discovered Adrenal Mass | journal=New England Journal of Medicine | publisher=Massachusetts Medical Society | volume=356 | issue=6 | date=February 8, 2007 | issn=0028-4793 | doi=10.1056/nejmcp065470 | pages=601–610}}</ref> In patients who do not yet have a confirmed cancer diagnosis, [[adrenal incidentaloma]] is infrequently caused by malignancy.<ref name="UpToDate j823">{{cite web | title=UpToDate | website=UpToDate |url=https://www.uptodate.com/contents/evaluation-and-management-of-the-adrenal-incidentaloma | access-date=February 9, 2024}}</ref>
=== Pheochromocytoma ===
{{Main|Pheochromocytoma}}
[[Pheochromocytoma]] originates from [[Chromaffin cell|chromaffin cells]] and is a kind of [[Neuroendocrine tumor|neuroendocrine tumor.]]<ref name="National Cancer Institute 2020 v048">{{cite web | title=Pheochromocytoma | website=National Cancer Institute | date=February 12, 2020 |url=https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-endocrine-tumor/pheochromocytoma | access-date=February 9, 2024}}</ref> [[Pheochromocytoma]]s are generally benign. 10% to 15% of [[Pheochromocytoma|pheochromocytomas]] have the potential to be cancerous.<ref name="Cleveland Clinic medical professional 2022 h734">{{cite web | author=Cleveland Clinic medical professional | title=Pheochromocytoma: Causes, Symptoms & Treatment | website=Cleveland Clinic | date=June 30, 2022 |url=https://my.clevelandclinic.org/health/diseases/23373-pheochromocytoma | access-date=February 9, 2024}}</ref>
== Hereditary disorders associated with adrenal tumors ==
=== Von Hippel–Lindau disease ===
{{Main|Von Hippel–Lindau disease}}
[[Von Hippel–Lindau disease]] is a rare genetic multi-system disorder where certain body parts develop non-cancerous tumors.<ref name="National Institute of Neurological Disorders and Stroke 2023 a897">{{cite web | title=Von Hippel-Lindau Disease (VHL) | website=National Institute of Neurological Disorders and Stroke | date=November 28, 2023 |url=https://www.ninds.nih.gov/health-information/disorders/von-hippel-lindau-disease-vhl | access-date=February 9, 2024}}</ref> [[Pheochromocytoma]]s are a particular kind of tumor that are linked to [[Von Hippel–Lindau disease|von Hippel-Lindau syndrome]]. [[Von Hippel–Lindau tumor suppressor|VHL]] gene mutations result in [[Von Hippel–Lindau disease|von Hippel-Lindau syndrome]].<ref name="MedlinePlus 2018 x387">{{cite web | title=Von Hippel-Lindau syndrome: MedlinePlus Genetics | website=MedlinePlus | date=October 1, 2018 |url=https://medlineplus.gov/genetics/condition/von-hippel-lindau-syndrome/ | access-date=February 9, 2024}}</ref>
=== Multiple endocrine neoplasia ===
{{Main|Multiple endocrine neoplasia}}
[[Multiple endocrine neoplasia]] results in tumors or overgrowth on one or more [[Endocrine gland|endocrine glands]].<ref name="pennmedicine.org y015">{{cite web | title= | website=pennmedicine.org |url=https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/multiple-endocrine-neoplasia | access-date=February 9, 2024}}</ref> [[Multiple endocrine neoplasia]] is classified into three main forms: [[Multiple endocrine neoplasia type 1|type 1]], [[Multiple endocrine neoplasia type 2|type 2]], and type 4. Multiple endocrine neoplasia can be brought on by mutations in the [[MEN1]], [[RET (gene)|RET]], and [[CDKN1B]] genes.<ref name="MedlinePlus 2017 a638">{{cite web | title=Multiple endocrine neoplasia: MedlinePlus Genetics | website=MedlinePlus | date=March 1, 2017 |url=https://medlineplus.gov/genetics/condition/multiple-endocrine-neoplasia/ | access-date=February 9, 2024}}</ref>
== Disorders of hormone over/under-production ==
=== Addison's disease ===
{{Main|Addison's disease}}
[[Addison's disease]], or primary [[adrenal insufficiency]], is an uncommon chronic illness characterized by insufficient production of [[cortisol]] and [[aldosterone]] by the [[Adrenal gland|adrenal glands]].<ref name="Cleveland Clinic medical professional 2023 i533">{{cite web | author=Cleveland Clinic medical professional | title=Addison's Disease: What It Is, Causes, Symptoms & Treatment | website=Cleveland Clinic | date=September 20, 2023 |url=https://my.clevelandclinic.org/health/diseases/15095-addisons-disease | access-date=February 9, 2024}}</ref> Chronic primary adrenal insufficiency is typically characterized by an extended period of [[malaise]], [[fatigue]], [[Anorexia (symptom)|anorexia]], [[weight loss]], joint and back pain, and skin darkening. [[Mineralocorticoid]] and [[glucocorticoid]] hormone deficiency must be physiologically replaced in order to treat primary [[adrenal insufficiency]].<ref name="Nieman Chanco Turner 2006 pp. 276–280">{{cite journal | last=Nieman | first=Lynnette K. | last2=Chanco Turner | first2=Maria L. | title=Addison's disease | journal=Clinics in Dermatology | publisher=Elsevier BV | volume=24 | issue=4 | year=2006 | issn=0738-081X | doi=10.1016/j.clindermatol.2006.04.006 | pages=276–280}}</ref>
=== Adrenal crisis ===
{{Main|Adrenal crisis}}
[[Adrenal crisis]] is a serious, life-threatening complication of [[adrenal insufficiency]]. [[Hypotension]], or [[hypovolemic shock]], is the main symptom of adrenal crisis, other indications and symptoms include [[weakness]], [[Anorexia (symptom)|anorexia]], [[nausea]], vomiting, fever, [[fatigue]], abnormal [[electrolyte]]s, [[confusion]], and coma.<ref name="Bouillon Acute Adrenal Insufficiency">{{cite journal | vauthors = Bouillon R | title = Acute adrenal insufficiency | journal = Endocrinology and Metabolism Clinics of North America | volume = 35 | issue = 4 | pages = 767–75, ix | date = December 2006 | pmid = 17127145 | doi = 10.1016/j.ecl.2006.09.004 | publisher = Elsevier BV }}</ref> Laboratory testing may detect [[lymphocytosis]], [[eosinophilia]], [[hyponatremia]], [[hyperkalemia]], [[hypoglycemia]], and on occasion, [[Hypercalcaemia|hypercalcemia]].<ref name="Adrenal Crisis NEJM">{{cite journal | vauthors = Rushworth RL, Torpy DJ, Falhammar H | title = Adrenal Crisis | journal = The New England Journal of Medicine | volume = 381 | issue = 9 | pages = 852–861 | date = August 2019 | pmid = 31461595 | doi = 10.1056/NEJMra1807486 | s2cid = 263427558 }}</ref>
=== Adrenal insufficiency ===
{{Main|Adrenal insufficiency}}
[[Adrenal insufficiency]] is the clinical sign of insufficient [[glucocorticoid]] production or action, with or without concurrent insufficiency in [[Mineralocorticoid|mineralocorticoids]] and adrenal [[Androgen|androgens]].<ref name="Charmandari Nicolaides Chrousos 2014 pp. 2152–2167">{{cite journal | last=Charmandari | first=Evangelia | last2=Nicolaides | first2=Nicolas C | last3=Chrousos | first3=George P | title=Adrenal insufficiency | journal=The Lancet | publisher=Elsevier BV | volume=383 | issue=9935 | year=2014 | issn=0140-6736 | doi=10.1016/s0140-6736(13)61684-0 | pages=2152–2167}}</ref> [[Adrenocorticotropic hormone deficiency]] or exogenous [[glucocorticoid]] or [[opioid]] medication suppression of [[adrenocorticotropic hormone]] can cause [[adrenal insufficiency]], as can primary adrenal disorders. Unintentional [[weight loss]], [[Anorexia (symptom)|anorexia]], [[Orthostatic hypotension|postural hypotension]], extreme exhaustion, muscle and [[abdominal pain]], and [[Hyponatremia|hyponatraemia]] are characteristic clinical features.<ref name="Husebye Pearce Krone Kämpe 2021 pp. 613–629">{{cite journal | last=Husebye | first=Eystein S | last2=Pearce | first2=Simon H | last3=Krone | first3=Nils P | last4=Kämpe | first4=Olle | title=Adrenal insufficiency | journal=The Lancet | publisher=Elsevier BV | volume=397 | issue=10274 | year=2021 | issn=0140-6736 | doi=10.1016/s0140-6736(21)00136-7 | pages=613–629}}</ref>
=== Congenital adrenal hyperplasia ===
{{Main|Congenital adrenal hyperplasia}}
[[Congenital adrenal hyperplasia]] is a group of [[Genetic disorder#Autosomal recessive|autosomal recessive disorders]] characterized by impaired [[cortisol]] synthesis.<ref name="pmid28576284">{{cite journal | vauthors = El-Maouche D, Arlt W, Merke DP | title = Congenital adrenal hyperplasia | journal = Lancet | volume = 390 | issue = 10108 | pages = 2194–2210 | date = November 2017 | pmid = 28576284 | doi = 10.1016/S0140-6736(17)31431-9 | s2cid = 13737960 |url=http://pure-oai.bham.ac.uk/ws/files/41341465/THELANCET_D_16_08898R1_2.pdf}}</ref><ref name="pmid30272171">{{cite journal | name-list-style=vanc |pmid=30272171|year=2018|last1=Speiser|first1=P. W.|last2=Arlt|first2=W.|last3=Auchus|first3=R. J.|last4=Baskin|first4=L. S.|last5=Conway|first5=G. S.|last6=Merke|first6=D. P.|author7=Meyer-Bahlburg HFL|last8=Miller|first8=W. L.|last9=Murad|first9=M. H.|last10=Oberfield|first10=S. E.|last11=White|first11=P. C.|title=Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline|journal=The Journal of Clinical Endocrinology and Metabolism|volume=103|issue=11|pages=4043–4088|doi=10.1210/jc.2018-01865|pmc=6456929}}</ref> It results from the deficiency of one of the five [[enzymes]] required for the [[Biosynthesis|synthesis]] of cortisol in the [[adrenal cortex]].<ref name="pmid12930931">{{cite journal | vauthors = Speiser PW, White PC | title = Congenital adrenal hyperplasia | journal = [[The New England Journal of Medicine]] | volume = 349 | issue = 8 | pages = 776–88 | date = August 2003 | pmid = 12930931 | doi = 10.1056/NEJMra021561}}</ref> Most of these disorders involve excessive or deficient production of [[hormone]]s such as [[glucocorticoid]]s, [[mineralocorticoid]]s, or [[sex steroid]]s,<ref>{{cite journal |last1=La |first1=Betty |last2=Tung |first2=Celestine |last3=Choi |first3=Eugene A. |last4=Nguyen |first4=Ha |title=A Gigantic Uterine Leiomyoma and Big Bilateral Adrenal Myelolipomas as a Result of Untreated Congenital Adrenal Hyperplasia |journal=AACE Clinical Case Reports |date=1 November 2021 |volume=7 |issue=6 |pages=342–345 |doi=10.1016/j.aace.2021.05.002 |pmid=34765728 |pmc=8573279 }}</ref><ref name="pmid30272171"/> and can alter development of [[primary sex characteristic|primary]] or [[secondary sex characteristic]]s in some affected [[infant]]s, children, or adults.<ref name="MilunskyMilunsky2010">{{cite book|author1=Aubrey Milunsky|author2=Jeff Milunsky|title=Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment|url=https://books.google.com/books?id=oKCmA4dOYtMC&pg=PA600|access-date=14 June 2010|date=29 January 2010|publisher=John Wiley and Sons|isbn=978-1-4051-9087-9|pages=600–}}</ref>
=== Cushing's disease ===
{{Main|Cushing's disease}}
[[Cushing's disease]] is an illness where an excess of [[adrenocorticotropic hormone]] (ACTH) is released by the [[pituitary gland]]. [[Cushing's syndrome|Cushing syndrome]] can be brought on by [[Cushing's disease|Cushing disease]].<ref name="MedlinePlus h199">{{cite web | title=Cushing disease: MedlinePlus Medical Encyclopedia | website=MedlinePlus |url=https://medlineplus.gov/ency/article/000348.htm | access-date=February 9, 2024}}</ref>
=== Hyperaldosteronism ===
{{Main|Hyperaldosteronism}}
[[Hyperaldosteronism]] is caused by the [[adrenal gland]]'s overproduction of the hormone [[aldosterone]]. The excess production of the [[adrenal gland]], specifically the [[zona glomerulosa]], is the cause of primary [[hyperaldosteronism]]. Excessive [[Renin–angiotensin system|renin-angiotensin-aldosterone system]] activation results in secondary [[hyperaldosteronism]].<ref name="Dominguez Muppidi Gupta 2023 p784">{{cite web | last=Dominguez | first=Alejandro | last2=Muppidi | first2=Vijayadershan | last3=Gupta | first3=Sonu | title=Hyperaldosteronism | publisher=StatPearls Publishing | date=February 12, 2023 | pmid=29763159 |url=https://www.ncbi.nlm.nih.gov/books/NBK499983/ | access-date=February 9, 2024}}</ref>
=== Hypoaldosteronism ===
{{Main|Hypoaldosteronism}}
[[Hypoaldosteronism]] is a clinical condition marked by either an [[aldosterone]] deficiency or impaired tissue-level action of the hormone. [[Angiotensin]] I to Angiotensin II conversion, adrenal aldosterone synthesis and secretion, abnormal target tissue response to [[aldosterone]], and renal [[renin]] production and secretion are all potential causes of the disorder.<ref name="Rajkumar Waseem 2023 l490">{{cite web | last=Rajkumar | first=Venkatraman | last2=Waseem | first2=Muhammad | title=Hypoaldosteronism | publisher=StatPearls Publishing | date=August 7, 2023 | pmid=32310452 |url=https://www.ncbi.nlm.nih.gov/books/NBK555992/ | access-date=February 9, 2024}}</ref>
== Notable people with adrenal gland disorders ==
* [[John F. Kennedy]], the 35th president of the United States was diagnosed with [[Addison’s disease]].<ref>{{cite journal | last = Mandel | first = Lee R. | title = Endocrine and Autoimmune Aspects of the Health History of John F. Kennedy | journal = Annals of Internal Medicine | volume = 151 | issue = 5 | pages = 350–354 | date = September 2009 | doi = 10.7326/0003-4819-151-5-200909010-00011 | pmid = 19721023 | doi-access = }}</ref>
* Some have suggested [[Jane Austen]] was an ''[[wikt:en:avant la lettre|avant la lettre]]'' case of [[Addison's Disease]], but others have disputed this.<ref>{{cite journal|last=Upfal| first=Annette|title=Jane Austen's lifelong health problems and final illness: New evidence points to a fatal Hodgkin's disease and excludes the widely accepted Addison's| journal=[[Medical Humanities]]|volume=31|year=2005|pages=3–11|url=http://mh.bmj.com/cgi/content/full/31/1/3 |doi=10.1136/jmh.2004.000193| pmid=23674643|publisher=[[BMJ]] Publishing Group|issue=1|doi-access=free}}</ref>
* Scientist [[Eugene Merle Shoemaker]], co-discoverer of the [[Comet Shoemaker-Levy 9]] had [[Addison's Disease]].<ref>{{cite web | first = Brian | last = Marsden |
== See also ==
* [[Adrenalism]]
* [[Adrenal tumor]]
== References ==
{{reflist}}
== Further reading ==
* {{cite journal | last=Vaughan | first=E.Darracott | title=Diseases of the adrenal gland | journal=Medical Clinics of North America | publisher=Elsevier BV | volume=88 | issue=2 | year=2004 | issn=0025-7125 | doi=10.1016/s0025-7125(03)00149-4 | pages=443–466 | ref=none}}
* {{cite journal | last=Takayanagi | first=R. | last2=Miura | first2=K. | last3=Nakagawa | first3=H. | last4=Nawata | first4=H. | title=Epidemiologic study of adrenal gland disorders in Japan | journal=Biomedicine & Pharmacotherapy | publisher=Elsevier BV | volume=54 | year=2000 | issn=0753-3322 | doi=10.1016/s0753-3322(00)80036-0 | pages=164s–168s | ref=none}}
== External links ==
* [https://my.clevelandclinic.org/health/diseases/16717-adrenal-disorders Cleveland Clinic]
* [https://www.mountsinai.org/care/surgery/services/endocrine-surgery/conditions/adrenal-gland Mount Sinai]
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{{Adrenal gland disorder}}
[[Category:Adrenal gland disorders| ]]
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