Adrenal glands

As the name suggests, adrenal glands are responsible for producing adrenaline – the hormone that makes your heart beat faster when you encounter stressful or exciting situations. But that’s not all they do.
 
In fact your adrenal glands produce hormones that help regulate a number of essential body functions including your metabolism, your immune system and your blood pressure. But if your adrenal glands don’t do their job properly, it can cause problems that have a serious effect on your health.

 

Where are the adrenal glands located?

Your adrenal glands – also known as suprarenal glands – are a pair of small glands that sit on top of each of your kidneys. 
 

Adrenal gland anatomy

The adrenal glands consist of two main parts wrapped in a protective layer called an adipose capsule:
 

• Adrenal medulla: this is the central part of the gland.

• Adrenal cortex: this is the outer part of the gland that surrounds the medulla (it has three zones – the zona glomerulosa, the zona fasciculata and the zona reticularis).

 

What hormones do the adrenal glands release?

Both parts of the adrenal glands release hormones straight into your bloodstream. Besides adrenaline, the other hormone produced by the adrenals that you’re likely to have heard of is cortisol. Made in the zona fasciculata of the adrenal cortex, cortisol is needed to keep your body running smoothly in a number of ways – for instance it regulates your blood pressure, it helps your body respond to stress and emergency situations, it suppresses inflammation, it helps regulate your blood sugar and it controls your sleep/wake cycle.
 
Cortisol production is the result of a chain of hormonal events. First your hypothalamus – a gland found in your brain – produces a hormone that stimulates another gland in your brain (the pituitary) to release yet another hormone, which then stimulates your adrenals to make and release cortisol. It’s a finely tuned affair, with the hypothalamus and pituitary glands detecting how much cortisol is in your bloodstream and ramping up production when there’s not enough and slowing it down when there’s too much.
 
Other hormones produced by your adrenal glands include:
 

• Aldosterone: made in the zona glomerulosa this is a key hormone for blood pressure regulation and also for balancing your sodium and potassium levels.

• Dehydroepandrosterone (DHEA): along with other hormones called androgenic steroids, this is made in the zona reticularis and helps produce other hormones, including the sex hormones oestrogen and testosterone.

• Adrenaline and noradrenaline: also called epinephrine and norepinephrine respectively, adrenaline and noradrenaline are made in the adrenal medulla. Besides other things, they are both involved in helping your body cope with stress by initiating the so-called fight-or-flight response, also called the stress response (basically this gives you the energy to either fight danger or run away from it by increasing your heart rate and your blood pressure).

 

Adrenal gland disorders

The most common problem with adrenal glands is when they produce too little or too much of some hormones. The main adrenal gland disorders are the following:
 

Adrenal insufficiency

Caused by low levels of adrenal hormones, this is a rare disorder that usually develops gradually. If it’s caused by a problem with the adrenal glands themselves, it’s called primary adrenal insufficiency – though you may be more familiar with its other name, Addison’s disease.
 
If you have Addison’s disease it means your adrenal gland is damaged and doesn’t produce enough cortisol or aldosterone. According to the NHS, around 9,000 people in the UK have Addison’s disease, with women more likely to develop it than men (i).
 

Adrenal insufficiency symptoms

 

The most common cause of Addison’s disease is autoimmunity, which is when your immune system attacks your adrenal glands and disrupts the production of cortisol and aldosterone in the adrenal cortex. Symptoms can be similar to depression or flu in the early stages, including lack of energy, low mood, poor appetite (leading to weight loss) and muscle weakness. When Addison’s disease progresses, other symptoms can come into play such as dizziness, fainting, cramps and extreme tiredness.
 

Treatment for Addison’s disease

Treatment includes medication to replace the missing hormones that you have to take for life. The good news is having Addison’s doesn’t usually affect your longevity, and you should be able to live fairly normally – though some people with Addison’s also develop other health conditions such as an underactive thyroid or diabetes, with others experiencing recurring episodes of fatigue.
 
Meanwhile secondary adrenal insufficiency happens when the hypothalamus and pituitary glands don’t produce enough adrenocorticotropin hormone (ACTH), the hormone that stimulates the adrenal glands to make cortisol. As a result, your cortisol levels can gradually plummet. Secondary adrenal insufficiency can affect people who have to take steroid medication for a long time to treat health problems such as asthma and rheumatoid arthritis. It can also be caused by pituitary gland tumours and when parts of the pituitary or hypothalamus glands are surgically removed.
 

Congenital adrenal hyperplasia

People with congenital adrenal hyperplasia usually inherit it from their parents at birth (experts believe most cases are passed down by both parents who are healthy but carriers of the disorder (ii)). Children born with congenital adrenal hyperplasia lack an enzyme that’s needed to produce cortisol or aldosterone, or both hormones. According to Great Ormond Street Hospital for Children, between one in 10,000 and one in 18,000 children are born with congenital adrenal hyperplasia every year (ii).
 

Congenital adrenal hyperplasia symptoms

If the enzyme deficiency is mild, children may have congenital adrenal hyperplasia for years before it’s diagnosed, often not until after puberty or later. If it’s severe, babies born with congenital adrenal hyperplasia can soon develop symptoms such as dehydration, heart rhythm problems, vomiting and a general failure to thrive. Baby girls can also be born with male-looking genitalia (atypical or ambiguous genitalia). Both sexes usually have too low levels of minerals – or electrolytes – in the body, particularly salt, as well as low blood sugar. 
 

Treatments for congenital adrenal hyperplasia

As with adrenal insufficiency, congenital adrenal hyperplasia is treated with replacement hormone medication.
 

Cushing’s syndrome   

This is a disorder that happens when the adrenal glands produce too much cortisol, with symptoms including weight gain (often with excess body fat on the chest and stomach), puffy face, a build-up of fat on the back of the neck and shoulders (buffalo hump), mood problems, reduced sex drive, fertility problems and skin that bruises easily. Like secondary adrenal insufficiency, Cushing’s syndrome can affect people who are long-term takers of steroid medicines.
 

Overactive adrenal glands  

 This is when the adrenal glands develop nodules that produce high levels of hormones.
 

Adrenal gland cancer   

Cancer-causing adrenal gland tumours are thankfully rare, with most caused by cancer spreading from another part of the body. According to the American Cancer Society , in around half of adrenal cancers, symptoms are caused by the release of hormones produced by the tumour:
 

• In children symptoms are most commonly caused by androgens (male hormones) and oestrogens (female hormones), and include excessive facial and body hair as well as early puberty in girls and enlarged breasts in boys.

• Men with oestrogen-producing tumours may also have enlarged and tender breasts, as well as sexual problems such as erectile dysfunction and loss of libido. Men with tumours that produce male hormones may not experience any symptoms.

• Women with oestrogen-producing tumours don’t often notice any symptoms either, but if their tumour produces male hormones they may experience excess facial and body hair, irregular periods and their voice becoming deeper.

• Adrenal tumours also sometimes produce high levels of cortisol (see Cushing’s syndrome, above) and, very rarely, aldosterone. In the case of the latter, symptoms can include high blood pressure, weakness, muscle cramps and low blood potassium levels. 

 
In the other half of adrenal cancer cases, symptoms happen because the tumour has grown so large that it presses on nearby organs. This can cause symptoms such as:
 

• Pain in the kidney area

• Feeling of fullness in the stomach

• Eating difficulties (as you may feel full very quickly)

Hyperaldosteronism and pheochromocytoma  

Both are conditions caused by the overproduction of hormones by the adrenal glands. They can cause raised blood pressure and other symptoms. 
 
Hyperaldosteronism is caused by the adrenal gland releasing too much aldosterone into the blood:
 

• Primary hyperaldosteronism is caused by a problem with the adrenal glands, with most cases being the result of a benign (noncancerous) adrenal gland tumour.

• Secondary hyperaldosteronism is caused by a problem somewhere else in the body that makes the adrenal glands release too much aldosterone, such as high blood pressure or heart, liver or kidney problems. It can also be a genetic problem.

 
Hyperaldosteronism treatment includes medication and surgery (though surgery is rarely used in cases of secondary hyperaldosteronism).
 
Pheochromocytoma is a type of tumour that grows from cells found in the adrenal glands called chromaffin cells. Most of these tumours are benign. Symptoms of pheochromocytoma include high blood pressure, sweating, irregular heartbeat and high blood pressure. However, some people with pheochromacytoma don’t have any symptoms at all.
 
Medicines that control high blood pressure are often used to treat pheochromacytoma, though in some cases surgery is used to remove the tumour or even the entire adrenal gland.
 

What is an adrenal crisis?

If you have an adrenal gland disorder that causes low cortisol levels you also have a risk of developing a sudden worsening of your symptoms. Called an adrenal crisis, this can happen when your cortisol level drops way too low, way too quickly. It’s a serious disorder that’s considered a medical emergency, as it can be fatal if left untreated. 
 
If you’re at risk of experiencing an adrenal crisis your doctor or specialist will explain what you should do if it happens. This usually involves giving yourself a hydrocortisone injection immediately (or having someone else inject you) and then calling 999 for an ambulance.
 

What is adrenal fatigue?

Many natural health practitioners use the term adrenal fatigue to describe a set of symptoms thought to be caused by problems with the adrenal glands. The main symptom is feeling tired and worn out all the time, even when you’re getting your fair share of sleep, plus you may find it hard to concentrate and function properly.
 
Adrenal fatigue is thought to be caused by having adrenal glands that can’t cope properly when you’re under stress  – for instance, it may be the result of your adrenal glands not releasing enough cortisol when your life is particularly stressful or when you’re experiencing long-term stress. Some think it happens when your adrenal glands can’t keep up with your body’s need for cortisol.
 
However, unlike the other adrenal gland conditions mentioned above, adrenal fatigue is not yet a medically recognised condition. In fact, according to the US-based Endocrine Society there’s no scientific proof to support adrenal fatigue as a true medical condition; plus there’s a risk that, if you’re told you have adrenal fatigue, the real cause of your symptoms may not be diagnosed and treated (iii) (some of the other conditions that could cause tiredness, for instance, include anaemia, underactive thyroid, sleep apnoea, anxiety, fibromyalgia, diabetes and irritable bowel syndrome).
 
Patient UK, on the other hand, says it’s not unusual to feel very tired when you’re under a lot of stress, and it may well be that adrenal fatigue is quite common (iv).
 

Natural support for adrenal fatigue

Since it’s not a recognised medical condition and there are no official medical treatments for adrenal fatigue, the main remedy comes in the form of healthy lifestyle advice.
 

Eat healthy foods 

 
What you eat may help reduce the pressure on your adrenal glands, with a healthy nutritious diet key to having more energy. Choose plenty of vegetables and whole grains, plus healthy plant-based fats and plant-based or lean/low-fat animal-based protein foods.
 
One of the foods you should try to avoid, however, is sugar. This means not eating some types of fruit, though some relatively low-sugar fruits such as grapefruit, cherries, pears, plums and apples are considered suitable. Other foods to steer clear of include foods made from white flour, processed foods in general, artificial sweeteners, caffeine and fatty, fried foods.
 

Stay as active as possible

 
If you’re constantly tired, exercise may not be top of your list of priorities. But staying active on a regular basis is important, so try to aim for the official recommendation of having 150 minutes of moderate exercise each week (if you haven’t been very active lately, start slowly and build up to 150 minutes a week gradually). One of the ways exercise could help is that it promotes relaxation – other ways to relax include meditating or doing breathing exercises.
 

Sleep well  

 
Another way exercise can be beneficial is that it helps you sleep better (though not if you exercise too close to bedtime – try to stay active earlier in the day and relax more in the evening). It’s also a good idea to stick to a regular sleep routine, which includes going to bed and getting up at the same time every day. Find out more ways to improve your sleep by reading our guide to insomnia.
 

Quit smoking  

 
Many natural therapists advise smokers with adrenal fatigue symptoms to quit their habit because smoking is bad for your health in general. Read more about quitting smoking and the benefits it could bring you, plus what you can do to relieve some of the withdrawal symptoms associated with quitting by reading our stop smoking guide.
 

Drink alcohol in moderation  

 
Having too much alcohol really isn’t the best way to keep your adrenal glands healthy, even if you feel having a few drinks makes you feel less stressed (it may do so at the time but the next day you’ll probably feel worse). If you can’t cut alcohol out completely, try to stay within the official guidelines of having no more than 14 units of alcohol each week and spreading your units over at least three or four days if you regularly drink that much. There’s more advice on cutting back on booze in our guide to alcohol misuse.
 

Supplements for adrenal fatigue

Besides the lifestyle factors listed above there are several nutritional supplements that may help if you suspect your adrenal glands need a bit of a boost. Some supplements, for instance, could help support your energy levels while others help you deal more effectively with stress and feel more calm.

The first supplement you may want to consider is a high-strength multivitamin and mineral. This can be helpful because when we’re feeling over-stressed, it’s harder to consistently eat as healthily as we should. Taking a multivitamin and mineral can help make sure your body gets the nutrients it needs during these times. Look for a supplement with good levels of B vitamins, which help support your nervous system, and zinc, levels of which can be depleted when you’re under stress. There’s also some evidence to suggest multivitamins may be helpful when you’re stressed, with one study concluding that people taking a multivitamin and mineral supplement may experience lower levels of anxiety and cope better with stressful situations (v).

Other supplements that may support adrenal health include:
 

Vitamin C

Most of us probably know that vitamin C is needed for several important functions in the body, including keeping our cells protected and healthy, helping with wound healing and maintaining healthy skin, blood vessels, cartilage and bone. But it’s important for your adrenal glands too – in fact, the adrenals are among the organs that are thought to have the highest concentration of vitamin C in the entire body, with the vitamin found in both the adrenal cortex and the adrenal medulla (vi). Experts have also discovered the body secretes vitamin C from the adrenals as part of its stress response (vii). This suggests topping up your vitamin C levels may be helpful when you’re feeling overwhelmed or under pressure. You can get vitamin C from a wide range of foods – with good sources including green leafy vegetables, kiwi fruit, tomatoes and peppers – as well as in single or multivitamin supplements.
 

Vitamin E

Vitamin E is best known as a powerful antioxidant vitamin that protects your cells from damaging free radicals, which your body produces naturally when it uses oxygen. But you may not know it helps your blood and muscles use oxygen efficiently too. Some studies even suggest vitamin E deficiency may interfere with the production of cortisol by the adrenal glands – however the only studies published so far are based on animals, so any conclusions they draw aren’t as strong as human studies. Nevertheless many natural health practitioners recommend taking vitamin E supplements to help the body cope with stress and the lack of energy having low levels often causes.
 

Magnesium

This is an important mineral for reducing tiredness and fatigue as your body needs a good supply of magnesium to make and use a molecule called adenosine triphosphate (ATP), which is where your body’s cells store the energy you get from the food you eat (viii). Many experts believe your body’s level of magnesium may be also lowered when you’re under a lot of stress, with larger-than-normal levels excreted in urine (ix). There’s also some evidence to suggest taking magnesium may help you sleep better if stress is keeping you awake at night (x). It is, however, quite common to have a low magnesium level. If you’re interested in keeping yours at a healthy level, try taking a well-absorbed form of magnesium such as magnesium citrate.
 

Theanine

A non-protein amino acid, theanine is found almost exclusively in green, black, oolong and pekoe tea, as well as in supplements. Natural health practitioners believe it can make you feel calmer because of the way it helps your brain produce alpha waves – which may explain why many of us like to relax with a cuppa. The best part is that, while other medicines designed to help you feel less stressed can also make you feel drowsy, studies suggest theanine supplements have the same relaxing effect but without the drowsiness (xi). There’s also some evidence to suggest theanine may be helpful when you’re trying to cope with a stressful situation because it helps slow down your heart rate (xii).
 

Ashwagandha

A traditional Ayurvedic herb, ashwagandha – another adaptogen – has been used historically in Asia to relieve the effects of stress, with studies suggesting it may well be effective (xv). It could also help support your adrenals, since experts have found ashwagandha has a moderating effect on the hypothalamus-pituitary-adrenal axis (xvi) plus it may reduce cortisol levels in the bloodstream (xvii). If you’re interested in trying ashwagandha, look for a supplement with good amounts of withanolides, which are the herb’s active compounds.
 

Get support for adrenal health

 
Adrenal gland health is undoubtedly important for your wellbeing. If you have a recognised medical condition that affects your adrenals, there are medicines that can help you feel more like your old self again. But if you’re tired all the time, especially when you’re stressed out, and think you may be experiencing adrenal fatigue, there are ways to tackle it and get your adrenals back into better working order. To discover more about many other health conditions, take a tour around our pharmacy health library.

 

 
 
References:
 

1. Available online: https://www.nhs.uk/conditions/addisons-disease/

2. Available online: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/congenital-adrenal-hyperplasia-cah/

3. Available online: https://www.endocrine.org/patient-engagement/endocrine-library/adrenal-fatigue

4. Available online: https://patient.info/hormones/adrenal-fatigue

5. Schlebusch L. et al., A double-blind, placebo-controlled, double-centre study of the effects of an oral multivitamin-mineral combination on stress. S Afr Med J. 2000;90:1216-1223. Available online: https://pubmed.ncbi.nlm.nih.gov/11234653/

6. Patak. P, Willenberg. HS, Bornstein. SR. Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocr Res. 2004 Nov;30(4):871-5, doi: 10.1081/erc-200044126.Available online: https://www.tandfonline.com/doi/full/10.1081/ERC-200044126

7. Padayatty SJ. et al., Human adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone. Am J Clin Nutr. 2007 Jul;86(1):145-9. Available online: https://academic.oup.com/ajcn/article/86/1/145/4754391

8. Tardy AL. et al., Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence. Nutrients. 2020 Jan;12(1): 228. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019700/

9. Grases G. et al., Anxiety and stress among science students. Study of calcium and magnesium alterations. Magnes Res. 2006 Jun;19(2):102-6. Available online: http://www.eurostaga.com/pdf_estudios/tm/Mg_estres.pdf

10. Held K. et al., Oral MG(2+) supplementation reverses age-related neuroendocrine and sleep EEG changes in humans. Pharmacopsychiatry. 2002;35:135-143. Available online: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-2002-33195

11. Turkozu D. et al., L-theanine, unique amino acid of tea, and its metabolism health effects, and safety. Crit Rev Food Sci Nutr. 2017 May 24;57(8):1681-1687. Available online: https://www.ncbi.nlm.nih.gov/pubmed/26192072

12. Turkozu D. et al., L-theanine, unique amino acid of tea, and its metabolism health effects, and safety. Crit Rev Food Sci Nutr. 2017 May 24;57(8):1681-1687. Available online: https://www.ncbi.nlm.nih.gov/pubmed/26192072

13. Cropley M. et al., The Effects of Rhodiola rosea L.Extract on Anxiety, Stress, Cognition and Other Mood Symptoms. Phytother Res. 2015 Dec;1934-9. Available online: https://www.ncbi.nlm.nih.gov/pubmed/26192072

14. Lekomtseva. YM, Zhukova. I, Wacker. A. Rhodiola rosea in Subjects with Prolonged or Chronic Fatigue Symptoms: Results of an Open-Label Clinical Trial. Complement Med Res. 2017;24(1):46-52.Available online: https://www.karger.com/Article/FullText/457918

15. Auddy B. et al., A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. JANA. 2008;11(1):51-57. Available online: https://www.researchgate.net/publication/242151370_A_Standardized_Withania_Somnifera_Extract_Significantly_Reduces_Stress-Related_Parameters_in_Chronically_Stressed_Humans_A_Double-Blind_Randomized_Placebo-Controlled_Study

16. Lopresti AL. et al., An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract. Medicine (Baltimore). 2019 Sept;98(37): e17186. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750292/

17. Chandrasekhar . K, Kapoor. S, Anishetty. S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012 Jul ;34(3):255-62.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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