 In mammals, the adrenal glands (also known

as suprarenal glands) are the triangular-

shaped endocrine glands that sit on top of
the kidneys.
 They are chiefly responsible for releasing
hormones in conjunction with stress through
the synthesis of corticosteroids and
catecholamines, including cortisol and
adrenaline (epinephrine), respectively.
 Anatomically, the adrenal glands are located in
the retroperitoneum situated atop the kidneys,
one on each side. They are surrounded by an
adipose capsule and renal fascia. In humans, the
adrenal glands are found at the level of the 12th
thoracic vertebra.
 Each adrenal gland is separated into two distinct
structures, the adrenal cortex and medulla, both
of which produce hormones. The cortex mainly
produces cortisol, aldosterone, and androgens,
while the medulla chiefly produces epinephrine
and norepinephrine.
 The adrenal cortex is devoted to the synthesis of
corticosteroid hormones from cholesterol. Some cells
belong to the hypothalamic-pituitary-adrenal axis and
are the source of cortisol and corticosterone
synthesis. Under normal unstressed conditions, the
human adrenal glands produce the equivalent of 35–
40 mg of cortisone acetate per day.[1] Other cortical
cells produce androgens such as testosterone, while
some regulate water and electrolyte concentrations
by secreting aldosterone. In contrast to the direct
innervation of the medulla, the cortex is regulated by
neuroendocrine hormones secreted by the pituitary
gland and hypothalamus, as well as by the renin-
angiotensin system.
 The adrenal cortex comprises three zones, or
layers. This anatomic zonation can be
appreciated at the microscopic level, where
each zone can be recognized and
distinguished from one another based on
structural and anatomic characteristics.[2] The
adrenal cortex exhibits functional zonation as
well: by virtue of the characteristic enzymes
present in each zone, the zones produce and
secrete distinct hormones.[2]
 Zona glomerulosa
 The outermost layer, the zona glomerulosa is the main site
for production of mineralocorticoids, mainly aldosterone,
which is largely responsible for the long-term regulation of
blood pressure.
 Zona fasciculata
 Situated between the glomerulosa and reticularis, the zona
fasciculata is responsible for producing glucocorticoids,
chiefly cortisol in humans. The zona fasciculata secretes a
basal level of cortisol but can also produce bursts of the
hormone in response to adrenocorticotropic hormone
(ACTH) from the anterior pituitary.
 Zona reticularis
 The inner most cortical layer, the zona
reticularis produces androgens, mainly
dehydroepiandrosterone (DHEA) and DHEA
sulfate (DHEA-S) in humans.
 The adrenal medulla is the core of the adrenal
gland, and is surrounded by the adrenal cortex.
The chromaffin cells of the medulla, named for
their characteristic brown staining with chromic
acid salts, are the body's main source of the
circulating catecholamines adrenaline
(epinephrine) and noradrenaline
(norepinephrine). Derived from the amino acid
tyrosine, these water-soluble hormones are
major hormones underlying the fight-or-flight
response.
 Adrenal insufficiency is a condition in which the
adrenal glands, located above the kidneys, do
not produce adequate amounts of steroid
hormones (chemicals produced by the body that
regulate organ function), primarily cortisol, but
may also include impaired aldosterone
production (a mineralcorticoid) which regulates
sodium, potassium and water retention.[1][2]
Craving for salt or salty foods due to the urinary
losses of sodium is common.[3]
 Addison's disease is the worst degree of adrenal
insufficiency, which if not treated, results in
severe abdominal pains, diarrhea, vomiting,
profound muscle weakness and fatigue,
depression, extremely low blood pressure,
weight loss, kidney failure, changes in mood and
personality and shock may occur (adrenal
crisis).[4] An adrenal crisis often occurs if the
body is subjected to stress, such as an accident,
injury, surgery, or severe infection; death may
quickly follow.[4]
 Adrenal insufficiency can also occur when the
hypothalamus or the pituitary gland, both
located at the base of the skull, doesn't make
adequate amounts of the hormones that
assist in regulating adrenal function.[1][5][6]
This is called secondary adrenal insufficiency
and is caused by lack of production of ACTH
in the pituitary or lack of CRH in the
hypothalamus.[7]
 Primary adrenal insufficiency is due to
impairment of the adrenal glands.
 The most common subtype is called idiopathic or
unknown cause of adrenal insufficiency.
 Some are due to an autoimmune disease called
Addison's disease or autoimmune adrenalitis.
 Other cases are due to congenital adrenal
hyperplasia or an adenoma (tumor) of the adrenal
gland.
 Secondary adrenal insufficiency is caused by
impairment of the pituitary gland or
hypothalamus.[8] These can be due to a form
of cancer: a pituitary microadenoma, or a
hypothalamic tumor; Sheehan's syndrome,
which is associated with impairment of only
the pituitary gland; or a past head injury.
 Autoimmune (may be part of Type 2 autoimmune
polyglandular syndrome, which can include type I Diabetes
Mellitus), hyperthyroidism, autoimmune thyroid disease
(also known as autoimmune thyroiditis, Hashimoto's
thyroiditis and Hashimoto's disease)[9]. Hypogonadism and
pernicious anemia may also present with this syndrome.
 Adrenoleukodystrophy[10]
 Discontinuing corticosteroid therapy without tapering the
dosage (severe adrenal suppression with ACTH suppression)
 Illness or any other forms of stress (this is termed critical
illness–related corticosteroid insufficiency)
 kidney injury
 environmental
 genetics
 Head injury
 Radiation
 Surgery
 infections (eg, miliary tuberculosis affecting
the adrenal glands, meningitis,
histoplasmosis)
 congenital hypopituitarism
 congential hypoadrenalism
 chronic opioid use
 The person may show symptoms of hypoglycemia,
dehydration, weight loss and disorientation. They may
experience weakness, tiredness, dizziness, low blood
pressure that falls further when standing (orthostatic
hypotension), muscle aches, nausea, vomiting, and
diarrhea. These problems may develop gradually and
insidiously. Addison's can present with tanning of the skin
which may be patchy or even all over the body. In some
cases a person with normally light skin may be mistaken
for another race with darker pigmentation. Characteristic
sites of tanning are skin creases (e.g. of the hands) and the
inside of the cheek (buccal mucosa). Goitre and vitiligo
may also be present.[4]
 If the person is in adrenal crisis, the ACTH
stimulation test may be given.
 If not in crisis, cortisol, ACTH, aldosterone, renin,
potassium and sodium are tested from a blood
sample before the decision is made if the ACTH
stimulation test needs to be performed. X-rays
or CT of the adrenals may also be done.[1]
 The best test for adrenal insufficiency of
autoimmune origin, representing more than
90% of all cases in a Western population, is
measurement of 21-hydroxylase
autoantibodies.[13]
Adrenal crisis
 Intravenous fluids[4]
 Intravenous steroid (Solu-Cortef or
Solumedrol), later hydrocortisone,
prednisone or methylpredisolone tablets[4]
 Rest
Cortisol deficiency (primary and secondary)
 Adrenal cortical extract (usually in the form of a
supplement, non prescription in the United
States)
 Hydrocortisone (Cortef) (between 20 and 35
mg)[4]
 Prednisone (Deltasone) (7 1/2 mg)
 Prednisolone (Delta-Cortef) (7 1/2 mg)
 Methylprednisolone (Medrol) (6 mg)
 Dexamethasone (Decadron) (1/4 mg, some
doctors prescribe 1/2 to 1 mg, but those doses
tend to cause side effects resembling Cushing's
disease
Mineralcorticoid deficiency (low aldosterone)
 Fludrocortisone (Florinef) (To balance
sodium, potassium and increase water
retention)[4]