Syndromes Related to Adrenal Fatigue

Patients and healthcare providers alike often confuse other syndromes with adrenal fatigue. Although their features may overlap with adrenal fatigue (involving the production of cortisol and aldosterone), the conditions are in fact quite different.

Basics of Cushing's syndrome

Cushing's syndrome is a syndrome in which the body produces an excess amount of cortisol, just as in the early stages of adrenal fatigue. Common causes of Cushing's syndrome include the following:

  • An adenoma or benign growth on an adrenal gland

  • A growth on the pituitary gland that stimulates the production of ACTH (adrenocorticotropic hormone), resulting in excess production of cortisol by the adrenal glands

  • Certain cancers, like lung cancer, that can produce ACTH, causing excess cortisol production

Healthcare providers first suspect Cushing's syndrome based on one or more of the following symptoms:

  • The presence of a swollen face, which is often referred to as moon facies

  • A buffalo hump, which is a swelling on the back of the neck

  • Increased and lower-extremity swelling

  • The presence of abdominal obesity, particularly the appearance of abdominal striae (think of striae as stretch marks, like in pregnancy)

  • One or more aspects of metabolic syndrome, including high blood pressure, high blood glucose levels, obesity, and high triglycerides; triglycerides are a form of lipids (like cholesterol) that, when high (as measured on a blood test), can increase the risk of developing heart disease

Unlike adrenal fatigue, the diagnosis of Cushing's can be confirmed by measuring cortisol levels in the urine. Your healthcare provider may ask you to collect your urine in a specialized type of container over a 24-hour period in order to measure the amount of cortisol. A measurement of 50 micrograms of cortisol in 24-hour urine is strongly suggestive of Cushing's syndrome.

The treatment depends on the underlying cause of Cushing's syndrome:

  • If an adrenal adenoma is the cause, the adrenal gland may need to be removed, and you may need adrenal steroid replacement. The same goes for the pituitary gland.

  • If lung cancer is the cause, then the treatment is aimed at the underlying cancer, which can include chemotherapy, radiation therapy, surgery, or a combination of all three.

Basics of hyperaldosteronism

In hyperaldosteronism, the body produces too much aldosterone (just like in the early stages of adrenal fatigue). The most common cause of this condition is an adrenal adenoma, a benign growth on an adrenal gland. Another common cause is hyperplasia, a thickening of both adrenal glands.

Symptoms of excess aldosterone production include the following:

  • High blood pressure that's difficult to control, despite using multiple medications

  • On blood tests, persistently low potassium (hypokalemia), despite a more than adequate potassium replacement

Blood tests can confirm a diagnosis of hyperaldosteronism. Your healthcare provider will order the blood levels of the hormones renin and aldosterone. A very high aldosterone level and a very low renin level is confirmatory for this syndrome. Additional imaging tests, such as a CT scan, can confirm the presence of an adenoma.

Here's the treatment for hyperaldosteronism:

  • If an adenoma is present, physicians usually recommend that it be surgically removed.

  • If hyperplasia of the adrenal glands is present, then the treatment is the use of medications that inhibit aldosterone secretion, such as spironolactone (Aldactone).

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