PM Pediatrics

Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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The adrenaline rush…and everything else in your adrenal gland

 

“I’d like to introduce you to your adrenal glands.”

This comes out a bit awkward when you say it, truthfully. But never one to shy away from appearing a little “unusual,” I’ve actually said this in the clinical setting. Not the oddest thing I’ve ever said, but it probably is on the list. And look at me! Now it’s in writing for all eternity.

So what IS your adrenal gland, and why should you care about it anyway?

The adrenal glands, who also go by the alias “suprarenal” glands (25¢ word) based on their location above (“Supra” means above) the kidneys (renal), are little masses of tissue that actually have an important job in the body. The adrenals are responsible for plenty of hormonal regulation as well as secretion of stress hormones. They interact with areas of the brain like the hypothalamus and pituitary gland, which are other areas of hormone production and regulation.

Let’s start with the anatomy and function:

  • The outer adrenal CORTEX generates the body’s own steroids known as corticosteroids, which help manage the body’s inflammatory response and regulate protein, fat and carbohydrate metabolism.
  • The inner adrenal MEDULLA produces chemicals that I’m pretty sure you’ve heard of: epinephrine (so much 25¢) which people also call ADRENALINE, and Norepinephrine (25¢), known as noradrenaline. These 2 substances affect that heart rate, constrict blood vessels and help direct blood preferentially to vital organs such as the brain and heart during a stress response.

Seriously, check all that out — not exactly what I’d call an “incidental role” in the body processes! And yet most people have never even heard of the adrenal glands. I figure I’ll give them the attention they deserve.

When the adrenals are working appropriately, hormones are secreted in just the right amounts to fight infection, respond adequately to stress, and process proteins and fats. But what happens when something goes wrong? With such a vital function on which so many other organ systems depend, you can guess that things can go bad in a hurry.

Glands that aren’t working right usually either underfunction or overfunction. Let’s describe an example of these two scenarios, both of which can happen in children, although underfunctioning adrenals are more common in kids.

Addison’s Disease is what happens when the adrenal gland is underactive.

In this case, there’s not enough of the hormone it produces called “cortisol.” This steroid hormone is important for controlling the body’s use of fats, proteins and carbohydrates as well managing the immune response. Kind of a big deal. The cause of this disease is mostly unknown but thought to be as a result of infection or an autoimmune reaction (that’s when the body reacts against itself). It can also be brought on by taking corticosteroids as a medication (like prednisone), and it can be genetic, inherited on the X chromosome from a healthy female carrier. This is what we mostly see in pediatrics.


So what happens in Addison’s disease?

This can be a tricky one, because the symptoms are vague and may only be apparent when a child is under physical stress. Here are some examples:

  • weakness & fatigue
  • dehydration & weight loss
  • darkening of the skin
  • rapid pulse
  • muscle aches
  • vomiting and diarrhea
  • intolerance to cold

See what I mean? I think I’ve had nearly all of those symptoms at some point in the last year. That being said, for a child who persistently “crashes” during times of physical stress or illness, many physicians will check some blood tests to look for this disease. Checking the corticosteroid levels in the blood can make the diagnosis, and treatment is aimed at regulating the amount of hormone in the blood, often by giving a specific steroid supplement. Specialty care by a pediatric endocrinologist is important.

Alright, what about an adrenal gland that is producing TOO MUCH of these hormones?

It depends on which hormone is getting overproduced. There can be problems with overproduction of testosterone, which can lead to exaggerated male characteristics in both males and females. There can also be overproduction of a hormone called aldosterone, which can lead to high blood pressure and problems with potassium levels.

An example of overproduction of endogenous steroids is Cushing’s syndrome.

This is not often seen in children, but happens when there’s too much cortisol being made. These symptoms are a bit more suggestive of the disease:

  • upper body obesity/moon-shaped face
  • darkened, thin, fragile skin
  • acne and bruising
  • stretch marks on skin
  • high blood sugar
  • excessive hair growth in females
  • extreme fatigue
  • irregular/decreased menstrual cycle in females

Since this diagnosis is a bit more complex, a combination of urine testing/blood testing as well as MRI/CT imaging is typically used, and is also done under the supervision of an endocrinology specialist. Treatment depends on the exact cause. Often certain medications can be given to suppress the overproduction of a specific hormone.

I remember the adrenal system in medical school as being one of the MOST DIFFICULT to understand and appreciate. The scope and ramifications of malfunction are vast and complex, and as such, the diagnosis and treatment are as well. It requires extreme attention to detail as well as vigilant monitoring to keep all the chemicals in balance.

Part of my gig here in the world of digital media is to be a medical educator and try to help make sense of various diseases and raise awareness about them. Our very own adrenal glands sure aren’t flashy, and they do their thing without calling much attention to themselves, so it’s easy to saunter through life without even knowing they’re there.

But as for yours and your children’s, you’ve now been introduced. I hope you only meet briefly in passing, but now you’ll have some name recognition so that if the topic of adrenal glands comes up with your health or someone that you love, it will ring with some familiarity and you can say with confidence that “you’ve already met.”

Wishing you a week in perfect balance!

Keep Reading! Precision Medicine: One Size Does NOT Fit All

 

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