Adrenal disease covers a series of conditions that affect the adrenal glands, near the kidneys. They cause the glands to produce too many – or too few – hormones such as cortisol, adrenaline and aldosterone. The symptoms can be subtle and vary from patient to patient, so a careful diagnosis is essential to find the best treatment.

Cushing’s syndrome occurs when the body produces too much cortisol. It requires specialist consideration as it can be connected to adrenal tumours, including cancer.

Cushing’s disease is a specific type of Cushing’s syndrome caused by an overworking pituitary tumour, which stimulates the adrenal glands to produce more cortisol. Similarly, it requires specialist expertise to diagnose and treat.

Primary aldosteronism or Conn’s syndrome is a common cause of hypertension, and an even more common cause of severe hypertension. To diagnose, treat and completely cure it, careful specialist investigation is needed, working hand-in-hand with the laboratory and highly qualified nurses, radiologists and surgeons.

Primary adrenal failure or Addison’s disease is rare and very easy to miss. It can be fatal if untreated, so it’s essential to diagnose it accurately to keep patients safe. Once diagnosed, it’s relatively easy to treat, but keeping patients well for the years or decades they might develop Addison’s is harder, requiring careful work between patient, endocrinologist, laboratory and nurses, and often bringing in bone health and blood pressure control.

Patients on steroid tablets, inhalers, creams and drops are all at risk of developing secondary adrenal failure. In some parts of the world this is increasingly common where steroids are found in over-the-counter cosmetics. With good diagnosis and skillful management it is curable, and ongoing stewardship of patients using steroids is advisable.

Some of our work with colleagues in respiratory medicine has been around reducing the harm of steroids, looking at how the concentration of the dose can be safely reduced to improve patients’ long-term health.