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What Our Adrenal Glands Do (And What Happens if They Don't Work)

October 02, 2019

"When the adrenals are working well, we feel great, but they are such an important gland, that if they're not working, it has serious repercussions."

In this episode of Inside Health with Dr. Keller Wortham, MD, will address a commonly misunderstood gland — the adrenals. Recently, more people have been going to their doctors complaining of feeling worn out, stressed, and fatigued. Sometimes, they have been told that there is something wrong with their adrenals, or that they may have adrenal fatigue. But what are the adrenals and can they really get “fatigued”? In his two-part series on adrenals, Dr. Keller will go over the adrenals and what they do, some common adrenal issues, and whether they actually do get worn out and cause adrenal fatigue. 

Video Highlights

  • 01:21: What are the Adrenals?
  • 03:17: Structure and Function of Adrenal Glands
  • 09:33: Common Adrenal Gland Problems
  • 12:58: Wrap-Up

What are the Adrenals?  

The adrenals are little glands that sit right on the tops of your kidneys. In fact, that's where their name comes from: Ad, which means, on or to, and renal, or kidneys. The adrenals are responsible for producing very important hormones for our body’s metabolic functions, including some of our homeostasis; things that keep our bodies functioning with equilibrium.  

One of the most important hormones produced by the adrenals is adrenaline which gets its name from the adrenals. You may also know this hormone as epinephrine. Adrenaline and epinephrine are the same thing; they just have names derived from Latin and Greek origins, respectively. So, adrenal means, basically “on top of the kidney” in Latin, and Epinephrine is similar. Epi means “on top of” and nephrine is the Greek word for kidney (nephros), so that's where epinephrine comes from. The adrenals also produce some other important hormones, including things that help regulate blood pressure, immune system, and our “fight or flight” response.

When the adrenals are working well, we feel great, but they are such an important gland to our bodily function that if they're not working, it has serious repercussions. They're very important.

Structure and Function of Adrenal Glands

To properly understand the importance of these glands, let’s do a little anatomy lesson. This might get a little technical, but stick around; understanding how your body works can really make you feel empowered to address issues that may arise.

The adrenals are divided into different regions: 

Cortex

This is the outer layer, and it produces a bunch of things called steroids.  The full name of these are corticosteroids — they derive their name from the cortex. The cortex, and the steroids it produces, are further divided into three important layers: 

  • The first area is called the glomerulosa. It is the outermost portion of the cortex and it produces things called mineralocorticoids. Specifically, it produces one called aldosterone, a hormone that helps regulate our blood pressure, as well as how our kidneys manage salt. So, it's very important for optimizing what kidneys do with salt, how they hold onto fluid, and basically keeping our blood pressure in the sweet spot.  
  • The next layer underneath that glomerulosa layer is called the fasciculata layer. It's also part of the cortex, and it produces glucocorticoids, including cortisol. You've probably heard about cortisol before — it’s often referred to as the stress hormone. The glucocorticoids, or cortisol, are responsible for regulating the metabolism of our sugars and our proteins. It's also very important for regulating the immune system and it has a very anti-inflammatory effect. If you've ever had a steroid injection into your knee because of arthritis, or put a steroid cream on your skin for a rash, those are this type of steroid: glucocorticoids. They help reduce inflammation and tamp down the immune system. If you've ever taken prednisone long-term you might know that prednisone, which is something that mimics natural cortisol, can cause your blood sugars to go up. So taking prednisone for a long time can increase your risk for diabetes. Unfortunately, you can’t just quit cold turkey. You have to taper back off. That's because when you're taking something like prednisone, you suppress the natural production of cortisol and other hormones by the adrenal glands.
  • There's one more intersection called the zona reticularis. The zona reticularis is important because it makes our androgens, particularly one called DHEA. There's also another one called androstenedione. These are very important for regulating our sex hormones, which eventually travel to the testicles, or ovaries, which produce important hormones like testosterone in men and estrogen in women. The steroids produced in this intersection are the class of steroids that some bodybuilders take to increase muscle mass, called anabolic steroids.

Medulla

After the cortex layer, the adrenal gland has another area called the medulla. This is the marrow, or the inner part. It’s responsible for making catecholamines. These are hormones like epinephrine and norepinephrine (or adrenaline).  These hormones are responsible for our “fight or flight” response, which tells the body what to do in a stressful situation. 

When the adrenals are working well, we're getting adequate amounts of each of those hormones, which means our blood pressure is under control, our blood volume is good, our glucose is under control, our body is not inflamed, our immune system is in check, our sex steroids are coming on and helping our libido, muscle mass, and fertility, and our “fight or flight” response is normal. That means it's not hyperactive, and causing us to be stressed out all the time, but is ready for an appropriate response if we sense danger.  That's a lot of things that the adrenals do. The whole body can be affected when our adrenals aren't working.

Common Adrenal Gland Problems

When our adrenals aren't working well, some pretty bad things can happen. There are many diseases of the adrenal glands that have been studied, and which can be treated and cured.  We’re going to list some of them, so we can have a better understanding of things that can happen.

Cushing’s Disease

When our adrenals are making too much cortisol, that's the disease often referred to as Cushing's Syndrome or Cushing's Disease, depending on the origin of the problem. When that happens, cortisol is going through the roof, which, as we said, affects blood sugar, and can cause weight gain and lead to issues like diabetes. It can also lead to other problems, like osteoporosis. That's usually caused by some kind of tumor, either of the adrenal gland itself or the pituitary, which is a part of the brain that influences the adrenal.

Addison’s Disease

If our cortisol levels were too low, it could be a condition called Addison's disease. If you don’t have enough cortisol, that means your blood pressure can drop, and that means your sugar metabolism is really bad. You can actually go into something called hypovolemic shock, meaning you don't have enough fluid in your body to really maintain yourself. This can also result in hyperpigmentation of the skin. So, if you're someone who has a tan even though you never go in the sun, you might want to think about this particular condition, which is often caused by an autoimmune disease that's attacking the adrenal glands. 

Congenital Adrenal Hyperplasia

This is a condition where your body didn't make a certain enzyme because of a genetic mutation, which means that the adrenals just get out of whack; certain systems are working in overdrive and certain aren't working at all. And it just creates a big mess. It can create problems with all the different areas of the body that we talked about, that are influenced by the adrenals.

Tumors 

You can get tumors of the adrenal glands themselves, or the pituitary, which again is the part of the brain that affects the adrenal glands. These tumors are often benign, but they can create what's called a mass effect, meaning they get larger, and the size starts pushing on things and causing problems. Then you can get tumors of the medulla, that inner part of the adrenal gland. Remember, the medulla is what produces our catecholamines, epinephrine or adrenaline and norepinephrine. So, a tumor in that area can be producing so much epinephrine that your body is always revving up like it's ready for a fight-or-flight response.  

Someone with this kind of tumor, called a pheochromocytoma, it can produce so much epinephrine that you feel anxious. You may find that your heart is racing, you're sweating all the time, maybe you have diarrhea, or maybe your blood pressure is through the roof. Those can all be signs of a tumor of that inner portion of your adrenal glands.

Wrap-Up

So, those are some of the conditions that happen with your adrenal glands.  You may notice the one we haven’t mentioned — adrenal fatigue. There's a reason for that, which we will get into in Part 2 of this series about the adrenals. In the meantime, we hope this anatomy lesson about the adrenals was helpful. Stay tuned for part two, if you want the real skinny on adrenal fatigue!

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