There are two adrenal glands, one on top of each kidney. Each gland is roughly triangular in shape and approximately 1½ inches long and a ½ inch wide. The outer portion of the gland (cortex) secretes aldosterone, cortisol, and androgens (sex hormones). Aldosterone regulates the excretion of sodium (salt) and potassium in urine. Cortisol (hydrocortisone) has several important jobs, including marshaling the body’s reactions to stress and to inflammatory and allergic reactions. The adrenals are stimulated and controlled by adrenocorticotropin, produced by the pituitary gland.

Organ damage

Children or teens who had a kidney removed (e.g., treatment for Wilms tumor or kidney cancer) or an adrenal gland removed (e.g., for a neuroblastoma that started in an adrenal gland) usually function quite well with only one remaining gland. Abdominal radiation almost never damages the adrenal glands. Brain irradiation, however, can occasionally disrupt the functioning of the adrenal glands if the HPA was affected (seen only in rare cases when more than 5000 cGy of radiation was directed at the pituitary).

Signs and symptoms

The signs and symptoms of adrenal insufficiency are weight loss, lethargy, low stamina, low blood pressure, irritability, depression, craving for salty foods, darkening of areas of the skin, weakness, and vomiting. These symptoms can appear gradually or suddenly worsen during periods of stress—for example, during an illness or after an accident. The acute onset of symptoms is called an Addisonian crisis or acute adrenal insufficiency.

Symptoms of an Addisonian crisis include pain in the lower back, abdomen, or legs; severe vomiting and diarrhea; dehydration; low blood pressure; and loss of consciousness. Left untreated, it can be fatal.

A temporary form of adrenal insufficiency may occur when a person who has been receiving a glucocorticoid hormone (such as prednisone) for a long time suddenly stops taking the medication.

Screening and detection

Problems with the adrenal glands are rare after treatment for childhood cancer. However, cortisol levels should be checked in the following situations:

• If one adrenal gland was removed and the other gland received high doses of radiation

• If the pituitary received more than 5000 cGy of radiation

Healthcare providers should check cortisol levels in both the morning and evening. If cortisol is low, referral to an endocrinologist is necessary for further testing.

Medical management

Treatment for cortisol deficiencies is replacement hydrocortisone given once in the morning or in two equal doses. Higher doses are needed if you are ill or undergoing anesthesia.