Adrenal gland problems are conditions where the two small glands sitting on top of your kidneys produce too much or too little of the hormones your body depends on. These hormones control blood pressure, blood sugar, your stress response, and the balance of salt and water in your body. When production goes wrong in either direction, the effects can range from gradual fatigue and weight changes to a life-threatening emergency.
What the Adrenal Glands Actually Do
Each adrenal gland has two distinct parts that produce different hormones. The outer layer, called the cortex, makes three types: cortisol (your main stress hormone), aldosterone (which regulates blood pressure by controlling sodium and potassium), and small amounts of sex hormones that play a role in puberty and are the primary source of certain hormones in women. The inner core, called the medulla, produces adrenaline and noradrenaline, the chemicals behind your fight-or-flight response.
Cortisol alone touches nearly every system in your body. It raises blood sugar when you need energy, helps maintain blood pressure by keeping blood vessels responsive, regulates your immune system, and influences how your body stores fat. A normal morning cortisol level typically falls between 5 and 25 mcg/dL, and levels naturally fluctuate throughout the day, peaking in the early morning and dropping at night. Problems arise when cortisol stays too high, drops too low, or when any of the other adrenal hormones shift out of their normal range.
Too Little Cortisol: Adrenal Insufficiency
When the adrenal glands can’t produce enough cortisol, the condition is called adrenal insufficiency. The primary form, known as Addison’s disease, occurs when the glands themselves are damaged, often by the body’s own immune system attacking them. Secondary adrenal insufficiency happens when the pituitary gland in the brain stops sending the signal that tells the adrenals to produce cortisol. This is actually more common than Addison’s disease and frequently develops after someone stops taking corticosteroid medications they’ve been on for a long time.
The symptoms build gradually and are easy to dismiss. Chronic fatigue, muscle weakness, loss of appetite, and unexplained weight loss are the most common. Many people also experience low blood pressure that drops further when standing up, causing dizziness or fainting. Nausea, abdominal pain, joint pain, and cravings for salty foods are typical. Women may notice irregular or absent periods. People with Addison’s disease specifically often develop darkened patches of skin, particularly visible on scars, skin folds, knuckles, elbows, and the inside of the cheeks.
Because these symptoms overlap with so many other conditions, adrenal insufficiency often goes undiagnosed for months or years. The danger is that someone with undiagnosed insufficiency can be pushed into adrenal crisis by an infection, surgery, injury, or severe stress. Adrenal crisis is a medical emergency where blood pressure crashes, blood sugar drops dangerously low, and confusion can rapidly progress to shock and coma. It carries a mortality rate of about 0.5 per 100 patient-years among people with known adrenal insufficiency. One hallmark of adrenal crisis is low blood pressure that doesn’t respond to standard treatments, which is often the clue that triggers the correct diagnosis.
Too Much Cortisol: Cushing Syndrome
The opposite problem, an excess of cortisol, leads to Cushing syndrome. The most common cause by far is long-term use of corticosteroid medications prescribed for conditions like asthma, arthritis, or autoimmune diseases. When the body itself overproduces cortisol, it’s usually because a small tumor in the pituitary gland is sending too many signals to the adrenals. This specific form is called Cushing disease and occurs more often in women.
Cushing syndrome reshapes the body in distinctive ways. Fat accumulates in the midsection, face (sometimes called “moon face”), and upper back (a “buffalo hump”) while the arms and legs stay thin or lose muscle mass. Pink or purple stretch marks appear on the abdomen, hips, thighs, and underarms. The skin becomes thin, fragile, and bruises easily. Wounds heal slowly. Beyond appearance, Cushing syndrome raises blood pressure, can trigger type 2 diabetes, weakens bones, and causes significant mood changes including depression, anxiety, and irritability. Reduced sex drive and fertility problems affect both men and women.
Aldosterone Imbalance
Aldosterone controls how much sodium your kidneys retain and how much potassium they excrete. When a benign growth on one adrenal gland pumps out too much aldosterone, the condition is called primary aldosteronism, or Conn’s syndrome. High blood pressure and low potassium are its defining features. The blood pressure can become severe and resistant to standard medications, and the low potassium can cause muscle cramps, weakness, and dangerous heart rhythm irregularities.
Primary aldosteronism is more common than once thought. It’s now recognized as one of the leading causes of hard-to-treat high blood pressure. Left unmanaged, it significantly raises the risk of stroke, heart attack, heart failure, and kidney disease. On the other end, too little aldosterone, which occurs in Addison’s disease, leads to dangerously low sodium, high potassium, dehydration, and low blood pressure.
Adrenaline-Producing Tumors
A pheochromocytoma is a rare tumor in the adrenal medulla that floods the body with adrenaline and noradrenaline. The classic symptoms come in sudden episodes: pounding headaches, a racing heart, drenching sweats, chest tightness, shortness of breath, and intense anxiety. Blood pressure spikes dramatically during these episodes and can be life-threatening. Some tumors release noradrenaline continuously, causing persistently elevated blood pressure between episodes, while others release adrenaline in bursts, producing the more dramatic on-off pattern. These tumors are usually benign and curable with surgery, but they need to be identified because uncontrolled adrenaline surges can cause stroke or heart failure.
Congenital Adrenal Hyperplasia
Some adrenal problems are present from birth. Congenital adrenal hyperplasia (CAH) is a genetic condition where the adrenal glands lack an enzyme needed to produce cortisol normally. To compensate, the glands overproduce androgens (male-type sex hormones) instead.
The classic form is severe. Newborns with it have dangerously low cortisol, which can cause low blood sugar, low blood pressure, and adrenal crisis in the first weeks of life without treatment. The excess androgens can also affect genital development, particularly in girls. The nonclassic form is milder and far more common. Many people with nonclassic CAH don’t know they have it until they develop symptoms in adolescence or adulthood: irregular periods, excess facial or body hair, acne, and fertility challenges in women. Men with nonclassic CAH often have no noticeable symptoms at all. Nonclassic CAH is frequently misdiagnosed as polycystic ovary syndrome (PCOS) because the symptoms overlap so closely.
Adrenal Masses Found by Accident
With the rise of routine imaging for unrelated reasons, adrenal growths are increasingly discovered by chance. These are called adrenal incidentalomas, and they show up on roughly 4% of all abdominal CT scans. That number climbs to about 10% in people over 70. The vast majority are nonfunctional, meaning they don’t produce excess hormones and aren’t cancerous. Still, any incidental adrenal mass needs evaluation to rule out hormone overproduction and, less commonly, cancer. Most small, inactive masses are simply monitored with follow-up imaging.
What “Adrenal Fatigue” Actually Is
If you’ve come across the term “adrenal fatigue” online, it’s worth knowing that it is not a recognized medical diagnosis. The concept, coined in the late 1990s by a naturopath, suggests that chronic stress gradually exhausts the adrenal glands until they can no longer produce adequate cortisol. The Endocrine Society, the leading international organization for hormone specialists, does not recognize adrenal fatigue as a real condition. No scientific evidence supports the idea that stress can wear out otherwise healthy adrenal glands in this way.
That said, the symptoms people attribute to adrenal fatigue, including persistent tiredness, brain fog, and difficulty coping with stress, are very real. They just point to other causes: sleep disorders, depression, thyroid problems, actual adrenal insufficiency, or other medical conditions that deserve proper testing. The risk of accepting an “adrenal fatigue” label is that it can delay identification of what’s really going on, and the supplements often marketed for it are unregulated and unproven.