The adrenal glands are two small, triangular endocrine organs situated directly above the kidneys. Each gland is divided into the outer cortex, which produces steroid hormones, and the inner medulla, responsible for releasing catecholamines. While these glands produce substances necessary for life, survival without them is possible due to modern medical advancements. Living without the adrenal glands requires a strict, lifelong regimen of hormone replacement therapy and meticulous medical management to substitute the hormones the body can no longer produce naturally.
The Critical Roles of Adrenal Hormones
The hormones produced by the adrenal cortex and medulla manage the body’s fundamental processes. The outer cortex produces two primary groups of steroid hormones: glucocorticoids and mineralocorticoids. Cortisol, the main glucocorticoid, regulates metabolism by helping the body convert fats, proteins, and carbohydrates into usable energy, especially during stress. Cortisol also modulates the immune system and controls inflammatory responses throughout the body.
The second major hormone from the cortex is aldosterone, a mineralocorticoid that maintains blood pressure. Aldosterone signals the kidneys to manage the balance of sodium and water in the bloodstream, while also controlling potassium levels. The adrenal medulla produces the catecholamines adrenaline (epinephrine) and norepinephrine. These neurotransmitters drive the body’s rapid “fight-or-flight” response, causing an immediate increase in heart rate, blood pressure, and blood glucose availability.
Lifelong Management Through Hormone Replacement Therapy
Since the body cannot function without adrenal hormones, individuals must adhere to a continuous hormone replacement therapy (HRT) schedule. This treatment involves replacing both the glucocorticoid and the mineralocorticoid components. Glucocorticoid replacement typically involves taking hydrocortisone or cortisone acetate orally, substituting for natural cortisol. The dosage is often split into two or three daily doses, with the largest dose taken in the morning to imitate the body’s natural circadian rhythm of cortisol release.
Mineralocorticoid replacement is accomplished using fludrocortisone, which manages the balance of sodium, potassium, and water. The dosage is usually taken once daily and is adjusted based on clinical signs, such as blood pressure stability, and monitoring of serum electrolyte levels. Regular monitoring ensures the replacement dose remains physiological—similar to the amount a healthy body would produce—thereby avoiding the side effects associated with pharmacological steroid doses.
A major component of successful management is “stress dosing,” which requires patients to temporarily increase their glucocorticoid medication during times of increased physical demand. Simple illnesses like a fever, the flu, or minor injuries place a strain on the body that necessitates a higher-than-normal cortisol level. Failure to increase the dose during these times can quickly lead to acute insufficiency, making patient education on this adjustment a central part of their care plan.
Recognizing and Handling Adrenal Crisis
The primary life-threatening risk for a person without adrenal glands is an adrenal crisis, also known as acute adrenal insufficiency. This condition occurs when the body’s demand for cortisol suddenly exceeds the replacement dose, often triggered by severe illness, trauma, or surgery. Symptoms include severe low blood pressure, profound fatigue, vomiting, abdominal pain, and confusion, which can rapidly progress to circulatory collapse and shock.
The immediate treatment for a suspected adrenal crisis is the rapid administration of high-dose glucocorticoids, typically a 100 mg injection of hydrocortisone (Solu-Cortef). Healthcare providers initiate this emergency therapy immediately, without waiting for confirmatory diagnostic tests, as any delay can be fatal. Following the injection, rapid fluid resuscitation with intravenous saline is required to restore blood volume and correct severe dehydration and electrolyte imbalances.
To prepare for such emergencies, all individuals with adrenal insufficiency must carry an emergency injection kit and wear medical identification, such as a bracelet or necklace. This identification alerts emergency responders to the patient’s condition, the need for immediate steroid injection, and the specific medication required. Proper preparation and awareness of the warning signs are necessary to manage this condition effectively and ensure long-term health.