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You feel stressed, overworked and noticed that you've put on extra weight recently. You could explain it away as just a bad diet and too much work but what if the problem still persists after exercising and dieting? What if you have an adrenal disorder?

The adrenal glands are small but a significant component of the stress response during times of anxiety. Relaxation techniques are designed to help down regulate these responses at times but when patients have pathological conditions on their adrenal glands, these techniques will not be enough. With such responsibilities like metabolism, regulation of the blood pressure and balancing both glucose and salts, it is no surprise that any irregularity could be fatal if not treated quickly and aggressively [1]. All these changes can be controlled by a simple hormone called cortisol so it is important to understand the process in order to see how these diseases can be all linked together. 

Cortisol's link to depression and anxiety

The responses of the adrenal glands are directly dependent on the hypothalamus-pituitary-adrenal axis (HPA axis). Both the hypothalamus and the pituitary gland are located in the brain and these structures will naturally secrete substances that cause cortisol — the "stress" hormone -- to be secreted in the adrenal glands of the kidneys [2].  There is a central-belief in medicine that a disturbance in the HPA axis can directly lead to an imbalance in the level of cortisol that is produced in the body. As the pathway produces more cortisol, patients will begin to notice symptoms like tachycardia, flushing and anxiety [3]. 

One theory suggests that as the body responds to the stress of having high levels of cortisol, a patient will undergo a sense of malaise and anxiousness that can be quite alarming. Because these early pathologies can often go unnoticed on CT and Ultrasound scans, patients may suffer from increased cortisol levels for a long-period before the definite diagnosis can be reached. 

The HPA axis can be altered by a number of disorders such as tumors and prolonged stress. Studies show that stress actually has a positive-feedback mechanism — be mindful because not all things "positive" are good for you.  As you become more stressed, your HPA axis will secrete more and more cortisol and you will start to gain weight quickly. As you gain more weight, you will put more cortisol into your bloodstream and can add to even more weight [4]. This cascade is common and is called Cushing's disease and can result from tumors at any point along the HPA axis [5]. 

Another potential irregularity that can occur along the HPA axis is from a source not even within your body.  When patients are suffering from immunological disorders like arthritis, they will typically be treated with a regiment of corticosteroids to suppress the inflammation that is occurring within the body. Unfortunately, the improvement of symptoms will often come at a price and patients will inadvertently increase their cortisol levels as well. The steroids act as a signal to the adrenal glands and also cause additional cortisol to be secreted. This is exactly why patients who are prescribed steroids suffer from weight gain and skin changes during their treatments. [6]

Be mindful of potential tumors 

Although much rarer than Cushing's disease, a pheochromocytoma is a potential risk that could make any relaxation technique for anxiety and stress utterly useless. These tumors will manifest as severe hypertension, headaches, palpitations and sweating — a combination that is also quite comparable to the symptoms associated with excessive anxiety [7].  These tumors are exceptionally rare on their own and can be seen in around 1:100.000 patients although the number is believed to be much higher due to the difficulty in diagnosing this tumor until after post-mortem autopsies. They generally present in the fourth or fifth decades of life and can affect both males and females equally. There is a family predisposition so if a family member is diagnosed with the disease, it is paramount to screen yourself immediately. [8]

Although rare on their own, pheochromocytomas can be part of a much larger spectrum of disorders known as the MEN 2 gene mutations. This specific mutation occurs due to changes in the DNA and can lead to widespread cancers in individuals over several groups of organs. The prevalence of MEN 2 is believed to be 1:35.000, much more likely than a pheochromocytoma by itself [9]. The MEN 2 mutation can result in a predisposition to developing pheochromocytomas, medullary thyroid tumors, and parathyroid tumors and patients diagnosed with this disease are likely to have pheochromocytomas in around 40% of cases [10]. 

Adrenal tumors pose a difficult challenge for physicians because they can be very small and still cause a reaction in the body. Considerable improvement has been made in the last decade in diagnostics and surgically removing a diseased kidney can correct the symptoms for most patients. Patients are able to survive with one kidney so the prognosis for a patient is much better in the current state of healthcare. [11]

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