Understanding Adrenal Health: Rare Conditions and When Testing and Treatment for Cortisol Imbalances

Hormones play an essential role in regulating various bodily functions, and for women, understanding how they impact overall health can be crucial. While most people will never need to worry about adrenal health or cortisol imbalances, there are rare situations where these conditions may warrant further investigation.

At Complete Healthcare for Women, we’re dedicated to providing thorough evaluations and support for our patients. In this article we’ll discuss the rare instances in which testing for cortisol imbalances may be appropriate, as well as the treatments available if needed.  If testing is necessary, it would be done through an endocrinologist.

The Role of Cortisol and the Adrenal Glands

Cortisol is often called the "stress hormone" because it helps the body respond to stress, regulate blood pressure, and manage energy levels. The adrenal glands, which are located above the kidneys, produce cortisol. While cortisol plays a critical role in health, imbalances are uncommon and only rarely cause significant health issues.

Symptoms that could suggest an adrenal concern, though rare, include:

• Persistent fatigue or unexplained changes in weight
• Muscle weakness
• High blood pressure or fluctuating blood pressure
• Skin changes, such as bruising easily or the appearance of purple stretch marks
• Mood changes, including increased irritability or depression

Because these symptoms can have many causes, most individuals will not require adrenal testing. However, for those with persistent symptoms that haven’t responded to conventional treatments, testing may provide answers.

Testing for Adrenal Health: What to Expect

If symptoms indicate the potential need for adrenal evaluation, several tests can assess cortisol levels and adrenal function. Here are some of the most common methods used:

1. 24-Hour Urine Free Cortisol Test

This test requires collecting urine over a full 24-hour period to measure cortisol production. This comprehensive approach helps assess cortisol levels across a complete day, as cortisol levels fluctuate naturally.

2. Late-Night Salivary Cortisol Test

In this test, saliva samples are collected late at night, usually around 11 p.m. Cortisol should be at its lowest during this time, and this test helps determine if levels are dropping appropriately.

3. Dexamethasone Suppression Test

This involves taking a dose of dexamethasone, a synthetic steroid, at night and then measuring cortisol levels in the blood the following morning. Normally, dexamethasone suppresses cortisol production. If levels remain high, it may indicate a cortisol imbalance.

4. ACTH (Adrenocorticotropic Hormone) Blood Test

This test measures the amount of ACTH in the blood, a hormone that stimulates cortisol production. It can help determine if the adrenal glands are responding correctly.

5. Imaging Studies

If there’s concern about a structural issue, imaging studies like CT or MRI scans can identify potential abnormalities in the adrenal glands.

These tests are only recommended in specific cases and provide a thorough look at how the adrenal glands are functioning.

Treatment Options for Cortisol Imbalance

For the rare instances when adrenal conditions are diagnosed, treatment options are available. The specific approach will depend on the diagnosis and severity of the condition. Here’s a look at some of the treatment possibilities:

1. Medications

For those with high cortisol levels, certain medications, such as ketoconazole or metyrapone, can help lower cortisol production. If cortisol levels are low, hormone replacement therapy with corticosteroids like hydrocortisone or prednisone can help restore balance.

2. Surgical Intervention

If imaging reveals a tumor, surgery may be needed to remove it. Adrenal tumors, while rare, can sometimes affect cortisol levels and require intervention.

3. Radiation Therapy

In cases where surgery isn’t an option or additional treatment is needed, radiation therapy can target and reduce tumor growth, particularly in the pituitary gland.

4. Lifestyle Modifications

Adopting stress management techniques, a balanced diet, and regular physical activity can also help support adrenal health and complement other treatments.

When to Consider Adrenal Testing

It’s important to remember that adrenal issues are rare, and most people with symptoms like fatigue, weight changes, or mood disturbances do not have an adrenal condition. In the majority of cases, these symptoms are due to more common health issues that can be managed with routine care.

If you experience persistent symptoms that do not respond to standard treatments, it may be worth discussing with your healthcare provider. However, for most, adrenal testing and treatment are not necessary.

At Complete Healthcare for Women, we’re here to help you understand your health needs and guide you in the best direction for your unique situation. If you have questions about adrenal health or cortisol levels, please contact our team at Complete Healthcare for Women.  509-392-6700.

Richard Lorenzo D.O

Kortney Jones ARNP

Author

Richard Lorenzo, DO Dr. Lorenzo is a Fellow of the American Congress of Obstetricians and Gynecologists (ACOG) and the American College of Osteopathic Obstetricians and Gynecologists (ACOOG), reflecting his expertise in women’s health. He provides comprehensive gynecological and obstetric services, including prenatal care up to 20 weeks, infertility evaluations, and general gynecology. Dr. Lorenzo specializes in advanced surgical techniques, offering minimally invasive procedures for abnormal uterine bleeding, endometriosis, and hysterectomy, ensuring quicker recovery and minimal discomfort for his patients. He is highly trained in high-risk obstetrics and adept at performing minimally invasive hysterectomies, providing women with effective solutions tailored to their needs. At Complete Healthcare for Women in Richland, WA, Dr. Lorenzo prioritizes personalized, compassionate care, empowering women to make informed health decisions.