Adrenal gland disorders are treated based on whether your adrenal glands are producing too much or too little of a specific hormone. The approach ranges from daily hormone replacement pills to surgery, depending on the condition. Because the adrenal glands produce several different hormones, including cortisol, aldosterone, and adrenaline, treatment looks very different from one disorder to the next.
Treating Addison’s Disease (Adrenal Insufficiency)
When your adrenal glands don’t produce enough cortisol, the primary treatment is replacing the missing hormones with oral medication you take every day for life. The cornerstone is hydrocortisone, typically 15 to 25 mg daily split into two or three doses. Smaller adults under about 145 pounds often do well with 10 mg in the morning and 5 mg around midday, while others take a three-dose schedule of 10 mg, 5 mg, and 2.5 mg spread across the day. The timing matters because it mimics your body’s natural cortisol rhythm, which peaks in the morning and tapers off by evening.
Some people use a longer-acting steroid instead, taking a single daily dose of 3 to 5 mg of prednisolone. If your aldosterone levels are also low, which is common in primary adrenal insufficiency, you’ll take a second medication called fludrocortisone at 50 to 200 micrograms once a day. This helps your body retain the right balance of sodium and potassium, keeping your blood pressure stable.
People with Addison’s disease often benefit from a higher-sodium diet, particularly those with low aldosterone. A dietitian can help you figure out the right amount for your situation. During hot weather or heavy exercise, you may need extra fluids and salt to compensate for what your body can’t regulate on its own.
Sick Day Rules
One of the most important things to learn with adrenal insufficiency is how to adjust your medication when your body is under extra stress. During illness with a fever over 101°F, you should triple each dose until you’ve been fever-free for 24 hours. The same tripling applies during vomiting, diarrhea, or extreme physical activity. For milder illnesses, doubling your dose for 24 to 48 hours is often sufficient. These adjustments replace the cortisol surge a healthy body would produce automatically during stress.
If you’re vomiting and can’t keep pills down, the situation can escalate quickly into an adrenal crisis, a life-threatening drop in cortisol. People with adrenal insufficiency should carry an emergency injection kit containing an injectable steroid, a syringe, and alcohol wipes, and know how to use it. Wearing a medical alert bracelet ensures that emergency responders know about your condition.
Treating Cushing’s Syndrome (Excess Cortisol)
Cushing’s syndrome is the opposite problem: too much cortisol. The cause determines the treatment. When a small tumor on the pituitary gland is driving the excess cortisol production, a neurosurgeon typically removes it through the nose, avoiding an external incision entirely. This procedure has a high success rate for small, well-defined tumors.
Sometimes the source of excess cortisol is a tumor elsewhere in the body that’s producing the signaling hormone ACTH. These tumors are removed through conventional or minimally invasive surgery. If the tumor can’t be found or fully removed and cortisol levels remain high, surgeons may remove both adrenal glands entirely. After that procedure, you’d need lifelong hormone replacement, essentially trading Cushing’s syndrome for managed adrenal insufficiency.
When surgery isn’t an option or doesn’t fully resolve the problem, medications that block cortisol production or its effects can help bring levels under control. Radiation therapy targeting the pituitary gland is another option, though it works more slowly, sometimes taking months to years to reach full effect.
Treating Hyperaldosteronism (Excess Aldosterone)
When one or both adrenal glands overproduce aldosterone, the result is high blood pressure that often resists standard treatments, along with low potassium levels. If the excess comes from a single adrenal gland (usually due to a benign tumor), surgical removal of that gland often cures the condition.
When both glands are overactive, or when surgery isn’t suitable, medications called mineralocorticoid receptor antagonists block aldosterone’s effects throughout the body. Spironolactone and eplerenone are the two primary options. They lower blood pressure by preventing aldosterone from causing your kidneys to retain excess sodium and water, and they also protect the heart, kidneys, and blood vessels from the long-term damage that chronically elevated aldosterone can cause. Eplerenone tends to have fewer hormonal side effects than spironolactone, which can sometimes cause breast tenderness or menstrual irregularities.
Treating Pheochromocytoma (Adrenaline-Producing Tumors)
Pheochromocytomas are tumors, usually benign, that form in the adrenal glands and release surges of adrenaline and related hormones. This causes episodes of dangerously high blood pressure, racing heart, sweating, and anxiety. Surgery to remove the tumor is the definitive treatment, but the preparation beforehand is critical.
Doctors start a specific type of blood pressure medication called an alpha-blocker 10 to 14 days before surgery. This relaxes blood vessels and normalizes blood pressure gradually. Only after the alpha-blocker is well established can a beta-blocker be added to control heart rate. Starting a beta-blocker first, or too early, can trigger a dangerous spike in blood pressure because of how these medications interact with excess adrenaline. This sequencing is one of the most important safety steps in managing pheochromocytoma.
What Adrenal Surgery Recovery Looks Like
Most adrenal gland surgeries today are performed laparoscopically or with robotic assistance, using small incisions rather than a large open cut. If you have a laparoscopic or robotic procedure, you’ll likely go home the same day. Open surgery, which is sometimes necessary for larger tumors, typically requires a hospital stay of up to five days.
During recovery, some pain around the incision sites is normal and can usually be managed with over-the-counter anti-inflammatory medications like ibuprofen. You’ll want to hold a pillow over your incisions when you cough or take a deep breath. Ease back into physical activity gradually, starting with short walks and checking with your provider before returning to more demanding activities. If only one adrenal gland was removed, the remaining gland typically compensates and produces enough hormones on its own, though this can take weeks to months.
Long-Term Monitoring
Adrenal disorders require ongoing follow-up, regardless of the specific condition. The Endocrine Society recommends that adults with primary adrenal insufficiency see an endocrinologist at least once a year, while infants need visits every three to four months. Pregnant women with adrenal insufficiency should be evaluated at least once per trimester.
At follow-up visits, your doctor will check blood electrolyte levels and ask about symptoms like salt cravings, dizziness when standing, blood pressure changes, and leg swelling. These signs help gauge whether your hormone replacement doses need adjusting. Plasma ACTH, renin, and aldosterone levels are used at diagnosis and periodically afterward to ensure treatment is on track. The goal of each annual review is to catch both over-replacement (taking too much medication) and under-replacement (not enough), since both cause their own set of problems over time.