The adrenal glands — small but mighty organs sitting atop each kidney — play a crucial role in hormone regulation. When their balance is disrupted, it can result in two major disorders: Addison’s Disease and Cushing’s Syndrome. Though both involve the adrenal cortex (the outer layer of the adrenal glands), they are polar opposites in how they affect the body.
Let’s break down their causes, symptoms, and treatments in a way that’s easy to understand.
🧠 Quick Overview: What Does the Adrenal Cortex Do?
To remember the adrenal cortex’s role, think of the 3 S’s:
- Sugar – Cortisol helps regulate blood glucose
- Salt – Aldosterone controls sodium levels and fluid balance
- Sex – Androgens influence sex hormones
🩺 Addison’s Disease: When Hormone Levels Are Too Low
Addison’s Disease is a condition where the adrenal cortex doesn’t produce enough hormones — especially cortisol and aldosterone.
💡 Think of Addison’s as a state where you need to ADD steroids.
🔹 Causes:
- Autoimmune destruction (most common)
- Infection (e.g., tuberculosis)
- Cancer or trauma to the adrenal glands
🔹 Symptoms: “Everything is Low” (except potassium and pigmentation)
- Low blood pressure, blood sugar, and sodium
- Low energy, mood, and temperature tolerance
- Weight loss, hair loss, irregular periods
- High potassium
- Bronze skin pigmentation
🚨 Addisonian Crisis:
A life-threatening emergency due to severe adrenal insufficiency.
- Signs: Severe hypotension, arrhythmias, extreme fatigue
- Treatment: IV fluids, glucocorticoids, and dextrose
🔹 Treatment:
- Lifelong steroid replacement (e.g., prednisone, hydrocortisone)
- High-protein, high-sodium, low-potassium diet
⚠️ Monitor for signs of over-treatment, which could lead to Cushing’s symptoms.
🌡️ Cushing’s Syndrome: When Hormone Levels Are Too High
Cushing’s Syndrome is caused by excess cortisol production — either from steroid overuse or tumors affecting the adrenal or pituitary glands.
💡 In Cushing’s, think “there’s a CUSHION of steroids.”
🔸 Causes:
- Long-term corticosteroid use
- Adrenal or pituitary tumors
- Adrenal hyperplasia (enlarged glands)
🔸 Symptoms: “Everything is High and Big” (except potassium)
- High blood pressure, blood sugar, and sodium
- Weight gain, especially in the face (“moon face”), belly, and upper back (buffalo hump)
- Purple stretch marks, thin skin, easy bruising
- Hair growth (especially facial, in women), menstrual irregularities
- Low potassium
🔸 Treatment:
- Gradual steroid tapering (never abruptly!)
- Adrenalectomy: If the adrenal gland is the source
- Hypophysectomy: If a pituitary tumor is responsible
Patients may require lifelong hormone replacement after surgery.
🔁 Addison’s vs Cushing’s: The Key Differences
| Feature | Addison’s | Cushing’s |
|---|---|---|
| Hormone Production | Low | High |
| Cortisol | ↓ | ↑ |
| Blood Pressure | Low | High |
| Potassium | High | Low |
| Body Weight | Loss | Gain |
| Pigmentation | Bronze skin | None |
| Face Appearance | Normal or sunken | Moon face |
| Treatment | Steroids for life | Taper steroids or surgery |
🧑⚕️ Final Thoughts
Recognizing the signs of adrenal dysfunction is vital for early diagnosis and treatment. Addison’s and Cushing’s present in completely opposite ways, but both require careful medical attention. Whether managing with medication or undergoing surgery, proper treatment can restore hormonal balance and improve quality of life.
Stay informed. Know your hormones. Advocate for your health.