The adrenal glands are two small, triangular-shaped endocrine organs located directly on top of each kidney. These glands are responsible for producing and releasing several hormones that are necessary for life, including cortisol, aldosterone, and adrenaline (epinephrine). Cortisol plays a role in regulating metabolism and the body’s response to stress, while aldosterone helps control blood pressure and electrolyte balance. The adrenal glands thus directly influence major bodily functions, and any dysfunction—whether overproduction or underproduction of these hormones—can lead to serious health issues.
The Primary Expert: Endocrinologists
The doctor most specifically trained to manage conditions of the adrenal glands is an endocrinologist. This medical specialization focuses on the endocrine system, which includes all glands and the hormones they produce. Endocrinologists undergo extensive training to understand the complex pathways that control hormone secretion. Their expertise covers the full spectrum of hormonal disorders, making them the definitive experts for adrenal gland dysfunction.
Endocrinologists diagnose and manage a range of conditions resulting from hormonal imbalances in the adrenal glands. Examples include Addison’s disease, which is characterized by insufficient production of cortisol and aldosterone, and Cushing’s syndrome, where the body has persistently high levels of cortisol. They also treat primary aldosteronism, a condition causing excess aldosterone that often leads to high blood pressure, and congenital adrenal hyperplasia, a genetic disorder affecting hormone synthesis. Non-surgical cases of pheochromocytoma, a tumor that releases too much adrenaline and noradrenaline, also fall under their care.
The diagnostic process often begins with detailed biochemical testing to measure hormone levels in the blood, urine, or saliva. A common test is the 24-hour urine collection, which provides a more accurate picture of total hormone output than a single blood draw. Endocrinologists also utilize dynamic testing, such as the dexamethasone suppression test for cortisol overproduction or the cosyntropin stimulation test for adrenal insufficiency. These specialized tests help pinpoint the exact nature of the hormonal problem.
Once a hormonal issue is identified, the endocrinologist determines the best course of medical management. This frequently involves hormone replacement therapy for deficiencies (e.g., Addison’s disease) or medications designed to block the production or action of excess hormones. They also order imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, to look for tumors or abnormal growths. The endocrinologist manages the condition long-term, restoring and maintaining the body’s hormonal balance through careful medication adjustments and monitoring.
The First Step: Primary Care and Initial Screening
The initial evaluation for a suspected adrenal gland problem typically begins with a Primary Care Physician (PCP) or an Internal Medicine doctor. These general practitioners act as the first line of defense, recognizing subtle or non-specific symptoms that might suggest an underlying endocrine issue. Patients commonly present with complaints such as unexplained fatigue, significant weight changes, or newly difficult-to-control high blood pressure, all of which can be linked to adrenal dysfunction.
The PCP’s initial work-up involves a thorough medical history and physical examination, looking for outward signs of hormonal excess or deficiency, such as changes in skin pigmentation or unusual fat distribution. They often order standard laboratory tests, including a basic metabolic panel, which can reveal abnormal sodium or potassium levels pointing toward an aldosterone issue. If an adrenal mass is incidentally discovered on an abdominal scan (an adrenal incidentaloma), the PCP initiates the first layer of evaluation.
If the initial blood work or symptoms strongly suggest a hormonal disorder, the PCP coordinates the transfer of care to an endocrinologist for specialized diagnostic testing. The PCP plays a coordinating role, ensuring that the patient’s overall health and chronic conditions, such as diabetes or hypertension, are managed while the specialist investigates the adrenal issue. They also manage follow-up for adrenal incidentalomas that are deemed small and non-functional, often recommending repeat imaging and hormonal checks over time.
Surgical and Advanced Care Specialists
When an adrenal condition requires physical removal of a tumor or the entire gland, surgical specialists become involved in the patient’s care. The most common surgeon for adrenal gland procedures is an endocrine surgeon, who has specialized training in operating on hormone-producing glands. These surgeons are preferred because of their high-volume experience with the delicate anatomy and the specific pre- and post-operative hormone management required for these cases.
The procedure to remove an adrenal gland or a tumor is called an adrenalectomy, which is typically performed using minimally invasive laparoscopic techniques. This involves making small incisions and using specialized instruments, allowing for a shorter recovery time and less post-operative pain compared to traditional open surgery. Urologists, who are trained in the surgical management of the urinary tract and organs near the kidneys, are also well-equipped to perform adrenalectomies and often participate in the surgical care of these patients.
Surgery is indicated for adrenal masses that are large (typically greater than 4 to 6 centimeters), those that show features suggestive of cancer on imaging, or those that are hormonally active, such as most pheochromocytomas or tumors causing uncontrollable Cushing’s syndrome. If the tumor is malignant, such as adrenocortical carcinoma, an oncologist or endocrine oncologist joins the team. The oncologist focuses on planning necessary post-surgical treatments, which may include chemotherapy or radiation therapy.