Endocrinology clinic Zakopane – Specialist clinics Medical Clinic Podhale Art. Welcome!

The adrenal glands are small glands located on the upper pole of the kidneys. They are made of cortical and spinal parts, which differ both in terms of structure and basic activities. The cortex of the adrenal gland is the main part of this gland – it is estimated that the cortex is about 80-90% of the entire adrenal gland.

The proper functioning of the adrenal glands is very important for human health and life. The main job of the adrenal glands is to make hormones that guide many of the body’s processes. The endocrinology clinic in Zakopane at the Medical Clinic Podhale Art deals with comprehensive diagnostics and treatment of adrenal diseases.

The hormones secreted by the cortical part of the adrenal glands are:

• Mineralocorticoids – hormones that are synthesized in the glomerular layer of the adrenal cortex. Among these hormones, aldosterone, an organic chemical compound from the group of steroids, has the strongest effect. Aldosterone is involved in the regulation of the body’s water and mineral balance, which means that it maintains the proper level of mineral salts and water in the body. This hormone influences the functioning of the renal tubules by increasing the absorption of sodium salts and limiting their excretion in the urine. Aldosterone also works by reducing the amount of blood that passes through the kidneys, thereby reducing the amount of urine passed out. Aldosterone also participates in transport processes in the kidneys. Additionally, this hormone, along with renin and angiotensin, regulates blood pressure.
• Glucocorticosteroids – hormones that are synthesized in the reticular and band layers. The most important and most powerful hormone in the group of glucocorticosteroids is cortisol, also known as the stress hormone. A characteristic feature of cortisol is the so-called the circadian rhythm of secretion, therefore its highest concentration is observed in the morning, while the lowest around midnight. Cortisol exhibits anti-inflammatory properties, which is why it is a common ingredient in powerful drugs to counteract inflammation. This hormone also affects the level of glucose in the blood, and more precisely causes an increase in glucose, e.g. in stressful moments.
• Sex hormones – androgens are produced in small amounts in the banded and reticular layers. They accelerate the growth of the body and the formation of secondary male sexual characteristics.

The hormones secreted by the medullary adrenal glands are catecholamines. These are compounds that circulate in the blood and are bound to plasma proteins. The highest concentration is achieved by:

• Adrenaline – Also called epinephrine, it is referred to as the fear, fight and flight hormone. The task of adrenaline is to influence the body’s response to stress or danger. The effects of adrenaline can be recognized from the accelerated heartbeat, increased blood pressure or dilated pupils. Adrenaline inhibits the peristaltic effect of the intestines and regulates blood glucose levels. It is given in the event of anaphylactic shock or resuscitation.
• Noradrenaline – shows adrenaline-like effects. It is produced in the adrenal medulla and also in the nucleus of the brain stem. The task of norepinephrine is to influence the circulatory system, in particular to increase systolic and diastolic blood pressure. This hormone acts on the intestinal sympathetic nerves, which in turn lowers the tonic tone in the intestines. During sleep, the release of norepinephrine is negligible, but it is enhanced by waking up and getting up.
• Dopamine – Dopamine is produced in small amounts in the adrenal medulla. It is synthesized mainly in neurons. This hormone greatly influences emotions. Dopamine also regulates the concentration of other hormones, especially prolactin. The action of dopamine increases blood pressure and the strength of muscle contraction. This property of dopamine is used in the treatment of traumatic, septic and cardiogenic shocks.

In the case of adrenal gland diseases, the endocrinology clinic in Zakopane offers:

• hormonal tests – determination of the level of cortisol, aldosterone or sex hormones in blood serum and urine, as well as determination of the level of adrenaline metabolites – vanillinmandelic acid or methoxycatecholamines in the daily collection of urine and in the blood serum,
• imaging tests – if a tumor on the adrenal glands is suspected, or to assess its size or location, abdominal ultrasound, computed tomography, magnetic resonance or scintigraphy are performed,
• adrenal biopsy – this involves taking a small sample of tissue, usually from only one adrenal gland.

Adrenal diseases can be divided into the following groups:

• diseases related to abnormalities in the secretion of hormones,
• diseases related to disorders of mineralocorticoid secretion, diseases related to the excess of androgens,
• adrenal cancer
• phaeochromocytoma.

It is a rare and usually benign tumor located on the adrenal glands. Diagnostics in this case is extremely important because an undiagnosed and untreated phaeochromocytoma may lead to a heart attack or hemorrhagic stroke. A tumor with varying severity manifests itself in different people.

The most characteristic symptoms are:

• high arterial pressure – the test shows very high values ​​of constant and paroxysmal pressure,
• trembling limbs,
• palpitations,
• pale skin, increased sweating,
• headaches which are closely related to high blood pressure.

Treatment of phaeochromocytoma consists in its complete surgical removal. However, before the operation takes place, the patient must take medications to regulate blood pressure and slow down the heart rate for some time.

Cushing’s syndrome is a disease that presents a variety of symptoms associated with increased levels of the glucocorticoids produced by the adrenal glands. People who suffer from rheumatoid arthritis or dermatitis, for example, are exposed to this ailment. Cushing’s syndrome can also be caused by an over-synthesis of cortisol in the adrenal glands. The symptoms of Cushing’s syndrome are always present when there is too much cortisol in the blood.

This can cause, for example:

• obesity, where fatty tissue accumulates on the face and torso, especially around the neck and abdomen,
• muscle atrophy of the lower and upper limbs,
• skin problems – erythema on the face, wide, red stretch marks on the abdomen, thighs, buttocks or breasts, acne, frequent bruises, swelling, and excessive male hair in women,
• excessive appetite,
• getting tired quickly,
• high blood pressure along with headaches,
• mental disorders such as depression, insomnia and problems with emotions
• menstrual disorders, loss of libido and male impotence,
• blurred vision.

Treatment of Cushing’s syndrome depends on the cause of the disease. If it was caused by a tumor of the adrenal gland, the optimal method of treatment is surgical removal of the entire adrenal gland. In the case of a pituitary tumor, it is necessary to remove the tumor itself. Moreover, prior to surgical treatment, the Patient is advised to use drugs that inhibit cortisol synthesis.

Addison’s disease is also known as primary adrenal insufficiency. It is a complex of symptoms caused by a chronic deficiency of hormones produced by the adrenal cortex. The symptoms of Addison’s disease are primarily skin changes. Characteristic skin discolorations are brown spots in places exposed to sunlight, elbows, flexion lines of the hands, scars or areola nipples.

Other symptoms of Addison’s disease include, for example:

• chronic fatigue with episodes of fainting,
• lack of willingness to exercise and physical activity,
• lack of resistance to stress and problems with coping with stressful situations,
• weight loss,
• nausea and vomiting.

Treatment consists of replenishing the hormones that should be produced by the adrenal glands. Treatment involves corticosteroid, mineralocorticoid and androgenic substitution.

Hyperaldosteronism is a disease related to the overproduction of aldosterone synthesized by the adrenal glands. The most commonly recognized symptom of hyperaldosteronism is markedly elevated blood pressure, resistant to any pharmacotherapy.

This, in turn, causes a number of other symptoms, including:

• paroxysmal headaches,
• blurred vision,
• pain in the chest,
• Heart arythmia,
• numbness in the arms, legs, feet and hands.

Treatment of hyperaldosteronism consists in regulating blood pressure and normalizing the concentration of potassium in the blood, therefore the chosen method of treatment is associated with the cause of the disease itself.

Hirsutism is a group of disorders in which hirsutism is observed in women in areas where hair is usually absent, i.e. on the chin, upper lip, chest, nipples, back or abdomen. In addition, the excess of male sex hormones in women causes male pattern baldness, skin changes, seborrhea, acne, menstrual disorders, obesity, infertility, and depression.

Its root cause is the action of male sex hormones or the excessive use of androgenic drugs. It may appear as a symptom of diseases of the ovaries and adrenal glands. It accompanies the polycystic ovary syndrome, a tumor of the adrenal gland or Cushing’s syndrome.

Choosing a method of treating hirsutism is associated with determining the cause of this ailment. If the cause is ovarian or adrenal tumors, a decision is made to surgically remove these lesions. If, on the other hand, hirsutism is medication-induced, treatment is resisted a discontinuation of the medications that caused the disease. To remove hair permanently, electrolysis and laser therapy are used. The use of cosmetic procedures without proper diagnosis often does not bring the expected results due to the existing hormonal disorders. Therefore, it is important to establish the causes and apply appropriate hormone therapy.

A malignant tumor may affect the adrenal cortex or their medulla. Rarely, metastases of tumors developing elsewhere in the adrenal glands are diagnosed. Malignant neoplasms of the adrenal glands are a very rare disease and the cause of their formation is genetically determined.

Symptoms of adrenal cancer are very diverse and they are dependent on the hormones produced by the tumor, including:

• high blood pressure that cannot be controlled with drugs
• excessive hair and menstrual disorders in women,
• enlargement of the mammary glands and decreased sex drive in men
• increasing body fat,
• skin problems and excessive sweating,
• diabetes.

The primary treatment for an adrenal gland tumor is surgery. During the operation, not only the tumor is removed, but the entire adrenal glands. If the tumor is not large, the procedure may be performed laparoscopically. When it is not possible to remove the tumor by surgery, chemotherapy or radiation therapy is used.

We cordially invite you to the endocrinology clinic at the Medical Clinic Podhale Art in Zakopane, where experienced specialists deal with the diagnosis and treatment of adrenal diseases.

Endocrinology outpatient clinic Zakopane – Specialist outpatient clinics Medical Clinic Podhale Art, Chramcówki 7, tel: +48 570 401 401