Adrenal gland problems produce different symptoms depending on whether the glands are making too much or too little of a specific hormone. The most common signs include persistent fatigue, unexplained weight changes, blood pressure that’s unusually high or low, and salt cravings. Because the two adrenal glands sit on top of your kidneys and produce several different hormones, the symptoms vary widely based on which hormone is out of balance.
How Adrenal Problems Show Up Differently
Your adrenal glands produce cortisol (your stress hormone), aldosterone (which controls blood pressure and salt balance), and androgens (sex hormones). A problem with any one of these creates a distinct pattern of symptoms. That’s why adrenal disorders can look like anything from chronic exhaustion to sudden panic attacks to unexplained weight gain, and why they’re often misdiagnosed for months or years before the real cause is identified.
The major categories break down into conditions where hormones are too low (adrenal insufficiency), too high (Cushing’s syndrome, overactive aldosterone, or adrenaline-producing tumors), or structurally abnormal (adrenal masses found incidentally on imaging). Each has its own symptom fingerprint.
Low Cortisol: Adrenal Insufficiency
When your adrenal glands don’t produce enough cortisol, the result is adrenal insufficiency. In its primary form, known as Addison’s disease, the adrenal glands themselves are damaged. In secondary adrenal insufficiency, the problem starts in the pituitary gland in your brain, which fails to send the right signals. The most common cause overall is actually long-term use of steroid medications like prednisone, which suppresses the adrenals’ ability to function on their own.
Symptoms tend to develop gradually. Early on, you might notice fatigue that doesn’t improve with rest, mild nausea, and a vague sense of feeling unwell. Over time, more distinctive signs appear:
- Skin darkening in specific areas, particularly on scars, skin folds, elbows, knees, knuckles, lips, and the inside of your cheeks. This hyperpigmentation is a hallmark of Addison’s disease specifically and doesn’t occur in secondary forms.
- Salt cravings that go beyond normal preference, driven by your body losing too much sodium.
- Low blood pressure that drops even further when you stand up, causing dizziness or fainting.
- Unintentional weight loss and loss of appetite.
- Muscle weakness and joint pain.
The gradual onset is part of what makes this condition tricky. Many people attribute the fatigue and weight loss to stress, poor sleep, or depression. By the time the diagnosis is made, symptoms have often been present for months. If you’ve been taking steroid medications (including inhaled steroids, skin creams, or joint injections) and are tapering off, be aware that your adrenal glands may not bounce back immediately. The Endocrine Society’s 2024 guidelines specifically flag that even non-oral steroid formulations can suppress adrenal function enough to cause insufficiency during or after treatment.
Too Much Cortisol: Cushing’s Syndrome
The opposite problem, where the adrenals produce excess cortisol, causes Cushing’s syndrome. The physical changes are often visible and distinctive. Fat redistributes in a characteristic pattern: a round, full face, a fatty hump between the shoulders, and weight gain concentrated in the midsection while the arms and legs may actually thin out.
One of the most telling signs is wide, purple stretch marks appearing on the abdomen, breasts, hips, and under the arms. These are different from the pale, silvery stretch marks that come from normal weight gain or pregnancy. They’re typically wider than 1 centimeter and have a reddish-purple color.
Beyond the visible changes, Cushing’s syndrome causes skin that bruises easily, slow wound healing, muscle weakness (especially in the thighs and upper arms), high blood sugar, and high blood pressure. Women may notice irregular periods, excess facial or body hair, and acne. Men may experience decreased fertility and reduced sex drive. Mood changes, including anxiety, irritability, and depression, are common and sometimes severe enough to be the first symptom that sends someone to a doctor.
Excess Aldosterone: Conn’s Syndrome
Primary hyperaldosteronism, also called Conn’s syndrome, happens when the adrenal glands overproduce aldosterone, the hormone that regulates your sodium and potassium balance. The two hallmark features are high blood pressure and low potassium levels in the blood.
The high blood pressure in Conn’s syndrome is often resistant to treatment, meaning it doesn’t respond well to standard blood pressure medications. That’s frequently what prompts further investigation. Low potassium, meanwhile, can cause muscle cramps, weakness, excessive thirst, and frequent urination. Some people notice heart palpitations or numbness and tingling. This condition is estimated to be the underlying cause in a significant portion of people with treatment-resistant hypertension, making it more common than many physicians historically assumed.
Adrenaline-Producing Tumors
A pheochromocytoma is a rare tumor of the adrenal gland that produces surges of adrenaline and related hormones. The symptoms come in dramatic, episodic “spells” rather than being constant. The classic combination is sudden severe headache, heavy sweating, and rapid heartbeat, often accompanied by a spike in blood pressure.
These episodes can last anywhere from minutes to hours and may be triggered by physical exertion, certain foods, stress, or even a change in body position. Between episodes, you may feel completely normal, which can make the condition confusing to diagnose. The spells can mimic panic attacks, and some people are initially treated for anxiety disorders before the true cause is discovered. The key distinguishing feature is that these episodes typically cause measurably high blood pressure during the spell, while panic attacks generally do not produce dangerous blood pressure elevations.
Adrenal Problems in Children
In children, adrenal disorders most commonly appear as congenital adrenal hyperplasia (CAH), a genetic condition present from birth. The adrenal glands overproduce androgens (male sex hormones), which affects development in distinct ways depending on severity.
In the classical form, the overproduction of androgens can cause early puberty, rapid growth during childhood, and paradoxically shorter adult height because the growth plates close prematurely. In the milder nonclassical form, children may show early puberty, a growth spurt during adolescence, and similarly reduced adult height. Girls may develop excess body hair or acne. Treatment requires careful balancing: too much replacement medication can stunt growth and cause excessive weight gain, while too little allows androgen levels to climb, triggering early puberty and shortening the window for normal growth.
Symptoms That Differ by Sex
Some adrenal symptoms are sex-specific because the adrenals produce androgens. When androgen production is excessive, the effects are most noticeable in women and prepubescent boys. Women may develop facial hair, a deeper voice, male-pattern hair thinning, acne, and irregular or absent menstrual periods. This pattern, called virilization, points specifically to an adrenal or ovarian source of excess androgens. In men, excess adrenal androgens are harder to detect because the testes already produce large amounts of testosterone, so the additional adrenal contribution is proportionally smaller.
Adrenal insufficiency also has sex-specific effects. In women, the loss of adrenal androgens can reduce body hair (especially underarm and pubic hair) and lower libido. Men with adrenal insufficiency may experience erectile dysfunction, though this is more commonly linked to the overall hormonal disruption and fatigue than to androgens alone.
Adrenal Crisis: The Emergency
The most dangerous manifestation of adrenal problems is an adrenal crisis, which occurs when cortisol levels drop critically low. This can happen in someone with known adrenal insufficiency who faces a physical stress like infection, surgery, or injury without increasing their medication. It can also be the first presentation of previously undiagnosed Addison’s disease.
Adrenal crisis comes on fast. Symptoms include severe abdominal or flank pain, nausea and vomiting, high fever, profound weakness, confusion or loss of consciousness, dangerously low blood pressure, and rapid heart rate. Blood sugar drops and dehydration sets in quickly. Without treatment, shock develops from the combination of very low blood pressure and cardiovascular instability, and the condition can be fatal.
Anyone with diagnosed adrenal insufficiency should be aware of the triggers: illness with fever, vomiting or diarrhea (which can prevent medication absorption), physical trauma, and surgery. These situations require an immediate increase in cortisol replacement, often called “stress dosing,” to prevent a crisis.
When Symptoms Overlap With Other Conditions
One reason adrenal disorders are frequently missed is that many of their symptoms, fatigue, weight changes, mood disturbances, muscle weakness, are shared with far more common conditions like depression, thyroid disease, diabetes, and chronic fatigue syndrome. A few patterns help distinguish adrenal issues from these lookalikes.
Skin darkening in sun-exposed and unexposed areas (like inside the mouth) is fairly unique to Addison’s disease. The combination of high blood pressure with low potassium is a strong signal for hyperaldosteronism. Purple stretch marks wider than a centimeter, especially combined with central weight gain and thin limbs, strongly suggest Cushing’s syndrome. Episodic spells of headache, sweating, and pounding heartbeat point toward pheochromocytoma. When standard blood tests come back normal but symptoms persist, a morning cortisol blood draw (normally between 10 and 20 micrograms per deciliter when measured between 6 and 8 a.m.) can be a useful screening step for cortisol-related disorders.