Adrenal gland problems produce different signs depending on whether your adrenals are making too much or too little of a particular hormone. The most common patterns fall into a few distinct categories: too little cortisol (adrenal insufficiency), too much cortisol (Cushing’s syndrome), excess adrenaline from a tumor, and overproduction of aldosterone. Each has its own signature set of symptoms, and some overlap enough to make the cause hard to pin down without testing.
Signs of Low Cortisol (Adrenal Insufficiency)
When the adrenal glands can’t produce enough cortisol, the body loses its ability to manage energy, blood pressure, and stress responses. The most common symptoms are chronic fatigue, muscle weakness, loss of appetite, and unexplained weight loss. These develop gradually, which is why many people attribute them to stress or aging before getting a diagnosis.
Beyond the core symptoms, adrenal insufficiency can cause nausea, vomiting, diarrhea, and abdominal pain. Blood pressure tends to run low and drops further when you stand up, leading to dizziness or fainting. Many people develop intense salt cravings because the body is losing sodium faster than normal. Low blood sugar episodes, irregular or absent menstrual periods, joint pain, and reduced sex drive are also common. Depression and irritability frequently appear early and can be the first noticeable change.
One of the most distinctive visible signs is skin darkening. In primary adrenal insufficiency (Addison’s disease), the body overproduces a signaling hormone that stimulates pigment cells as a side effect. This creates a bronze or tan appearance that’s most noticeable on scars, skin folds, knuckles, elbows, knees, lips, the palms, and the inside of the mouth. Nearly all adults with Addison’s disease develop this hyperpigmentation to some degree. People may also notice their hair darkening or dark bands forming on their nails.
Secondary adrenal insufficiency, caused by a problem with the pituitary gland rather than the adrenals themselves, shares most of the same symptoms but does not cause skin darkening. It’s more likely to cause low blood sugar episodes and less likely to cause dehydration or dangerous potassium imbalances.
Signs of Excess Cortisol (Cushing’s Syndrome)
When cortisol stays elevated for a long time, the body redistributes fat in characteristic ways. Weight gain concentrates in the midsection and face while the arms and legs stay thin or even lose muscle mass. The face becomes round (“moon face”), fat accumulates at the base of the neck and between the shoulders, and the neck appears thicker. These changes in body shape are often the first thing that prompts someone to seek medical attention.
The skin provides several telling clues. Wide, purple stretch marks (wider than 1 cm) appear on the abdomen, breasts, hips, and under the arms. These are distinctly different from the thinner, pink-silver stretch marks that come with pregnancy, growth spurts, or ordinary weight gain. The skin becomes fragile, sometimes described as having a “cigarette paper” quality on the elbows and backs of the hands. Bruising happens easily, wounds heal slowly, and acne-like breakouts may appear across the upper back, chest, and face.
Metabolically, prolonged high cortisol pushes the body toward insulin resistance, prediabetes, and eventually type 2 diabetes. Muscle weakness, particularly in the upper legs and arms, makes everyday tasks like climbing stairs or lifting objects noticeably harder. Children with Cushing’s syndrome tend to gain weight while their growth slows compared to peers.
Signs of Excess Adrenaline
A rare type of adrenal tumor called a pheochromocytoma produces surges of adrenaline and related stress hormones. The classic combination is episodic headaches, profuse sweating, and a pounding or racing heartbeat. Headaches occur in up to 90% of people with symptoms, sweating in 60 to 70%, and palpitations in about 70%. These episodes come in waves, lasting minutes to hours, and can be triggered by physical activity, certain foods, or even abdominal pressure.
Between episodes, some people feel completely fine, which makes the condition easy to dismiss. Most people with this type of tumor don’t experience all three classic symptoms together. High blood pressure that spikes unpredictably or resists standard treatment is often the finding that leads to diagnosis. Anxiety, trembling, and a sense of panic during episodes are also common because the body is essentially flooding itself with fight-or-flight hormones.
Signs of Excess Aldosterone
The adrenal glands also regulate salt and potassium balance through a hormone called aldosterone. When too much is produced, a condition called primary aldosteronism, the main sign is high blood pressure that’s difficult to control with typical medications. About 20% of people with resistant hypertension (blood pressure that doesn’t respond to three or more drugs) have this condition. In people with mildly elevated blood pressure, it’s far less common, affecting only about 2%.
Low potassium is the other hallmark, though it tends to appear later in the disease rather than at the start. When potassium drops, you might notice muscle cramps, weakness, excessive thirst, and frequent urination. Some people experience numbness or tingling. Because the blood pressure often comes first and the potassium issues later, many people are treated for ordinary hypertension for years before the adrenal cause is identified.
Visible Changes Worth Watching
Adrenal problems often leave visible evidence on the body, and recognizing these patterns can speed up diagnosis. Bronze or darkening skin, especially in creases, scars, and the inside of the mouth, points toward low cortisol. A round face with central weight gain, thin skin that bruises easily, and wide purple stretch marks suggest excess cortisol. Sudden episodes of flushing and sweating with a racing heart suggest an adrenaline-producing tumor.
Mood and cognitive changes appear across nearly all adrenal disorders. Depression, irritability, difficulty concentrating, and confusion are reported in both low and high cortisol states. These mental health symptoms are driven directly by hormone imbalances rather than being a secondary reaction to feeling unwell, which is why they often improve once the underlying adrenal problem is treated.
Adrenal Crisis: The Emergency
An adrenal crisis is the most dangerous consequence of adrenal insufficiency. It happens when someone whose adrenals aren’t functioning faces sudden physical stress, like an infection, injury, or surgery, without enough cortisol to respond. It can also occur when someone stops taking steroid medication abruptly.
The symptoms start vaguely: fatigue, nausea, vomiting, abdominal or back pain, and dizziness. What makes a crisis different from everyday adrenal insufficiency symptoms is the speed. These symptoms escalate rapidly into dangerously low blood pressure, confusion, loss of consciousness, and circulatory collapse. Without emergency treatment, it can be fatal. With proper treatment, blood pressure typically begins improving within the first hour and symptoms gradually resolve over the following two hours.
People with known adrenal insufficiency are usually given an emergency injection kit and taught to recognize the early warning signs so treatment can begin before the crisis becomes severe. Wearing a medical alert bracelet is standard practice, since a person in crisis may not be able to communicate their condition.