Adrenal glands are small, triangular-shaped glands located on top of both kidneys. They produce several hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions. These hormones, include adrenal steroids, such as aldosterone and cortisol, and adrenaline.
Adrenal conditions that we treat include primary adrenal insufficiency where the adrenal gland itself is not working. This is most commonly due to an autoimmune inflammation of the adrenals (often referred to as Addison’s disease) or to inborn disorders that impact the ability of the adrenal glands to produce cortisol, these conditions are called congenital adrenal hyperplasia. We put a lot of work in patient education as it is very important for patients with adrenal insufficiency to avoid a potentially life-threatening adrenal crisis, which can occur when increased demands for cortisol in stress and illness are not met by an appropriate increase in cortisol replacement. We regularly run patient education sessions including training on hydrocortisone self-injection.
Most adrenal lesions are incidentally discovered and, therefore, often called adrenal “incidentalomas”. The overwhelming majority of these nodules are not cancerous. Patients need careful evaluation to ensure that the lesion is not producing excess amounts of hormones and to ensure that their radiological characteristics indicate a benign tumour.
Adrenal tumours that arise from the outer zone of the adrenal gland, the adrenal cortex, can overproduce hormones such as cortisol (Cushing’s syndrome) or aldosterone (Conn’s syndrome). Often lesions that overproduce aldosterone are quite small and sometimes can be found in both adrenal glands, which requires careful assessment.
Adrenal cancer (also called adrenocortical carcinoma, ACC) is a very rare condition and may, in some cases, be associated with excessive production of certain adrenal hormones. Surgery, chemotherapy and radiotherapy may all be used for the treatment of this rare type of cancer. Patients with the possibility of this type of cancer will undergo detailed investigation and imaging in order to help guide treatment decisions.
Phaeochromocytomas are rare tumours which usually arise in the centre of the adrenal glands, the adrenal medulla. However, similar tumours may occur at other sites in the body when they are called paragangliomas. These tumours often produce the hormones adrenaline and noradrenaline which can cause many symptoms and elevated blood pressure. They are usually, but not always, non-cancerous. A proportion of people may develop the tumours as part of an underlying genetic condition and careful assessment including expert genetics advice, localization and treatment prior to surgical removal are essential.
The UHB Endocrine Department is one of the largest adrenal tumour centres in the UK and we have extensive specialist expertise in the management of adrenal cancer. All adrenal tumours are discussed in our regular Adrenal Multi-Disciplinary Team meetings and we offer a broad range of diagnostic tools, including biochemical tests and different imaging modalities. We regularly carry out adrenal vein sampling to determine whether aldosterone excess originates from one or both adrenals. We have excellent success rates, partly due to intraprocedural cortisol measurements that helps us to quickly determine whether the catheter is placed in the correct location.
All adrenal tumour patients are offered the opportunity to participate in research, which is carried out in collaboration with both national and international networks, namely the European Network for the Study of Adrenal Tumours (ENSAT), whose efforts have brought about many of the important breakthroughs for patients with adrenal tumours.