The adrenal glands play a crucial role in hormone regulation throughout our lives, but their function and associated disorders can vary significantly with age. From congenital adrenal hyperplasia in newborns to adrenal insufficiency in elderly patients, these small but mighty endocrine glands require specialized care when problems arise. At Mountain View Surgical Associates, we understand the complexities of adrenal disorders across the lifespan and provide comprehensive surgical management for adrenal conditions when needed.
Adrenal Disorders in Premature Infants and Newborns
Premature infants face unique challenges with their developing adrenal glands. Research shows that late-onset adrenal insufficiency in preterm infants isn’t necessarily due to absolute cortisol deficiency but rather a limited ability to synthesize sufficient cortisol relative to their stress levels. These infants often present with hypotension, oliguria, hyponatremia, and increased oxygen requirements—symptoms that can be mistaken for other conditions.
The most common adrenal disorder in newborns is congenital adrenal hyperplasia (CAH), affecting approximately 1 in 15,000-20,000 births. This autosomal recessive condition results from enzyme deficiencies in the cortisol production pathway, most commonly 21-hydroxylase deficiency accounting for 95% of cases. Newborn screening has dramatically improved early detection, allowing for prompt treatment with glucocorticoid replacement therapy and, when needed, mineralocorticoid supplementation.
Without proper diagnosis and management, infants with severe CAH may experience life-threatening adrenal crises characterized by vomiting, dehydration, hypoglycemia, and shock. Female infants may present with ambiguous genitalia, requiring specialized care from an interprofessional team including endocrinologists, surgeons, and genetic counselors.
What Are the Red Flags of Adrenal Crisis in Children?
Recognizing adrenal crisis in pediatric patients requires vigilance for specific warning signs. In children with central adrenal insufficiency (CAI), which results from pituitary gland disorders (secondary AI) or hypothalamic dysfunction (tertiary AI), symptoms can be particularly concerning. Severe hypoglycemia, seizures, and cholestatic jaundice may appear in newborns, while older children typically experience weakness, fatigue, nausea, and myalgia.
Unlike primary adrenal insufficiency, children with CAI don’t develop hyperpigmentation, and their electrolyte levels often remain normal. However, during times of stress or illness, these children can rapidly deteriorate. A morning cortisol level below 3 μg/dL strongly indicates adrenal insufficiency, while levels above 13 μg/dL generally suggest normal adrenal function.
According to the Journal of Clinical Endocrinology & Metabolism, immediate intervention with hydrocortisone is critical when adrenal crisis is suspected, as delays in treatment can lead to significant morbidity and mortality. Parents and caregivers must be educated about these warning signs and the importance of stress dosing during illness. Any child with known or suspected adrenal insufficiency who presents with lethargy, persistent vomiting, severe abdominal pain, or hypotension requires immediate medical attention and stress-dose glucocorticoids.
Pediatric Adrenocortical Tumors: Unique Challenges
Pediatric adrenocortical tumors (ACT) present distinctly different challenges compared to their adult counterparts. These rare tumors in children are frequently associated with genetic syndromes, particularly Li-Fraumeni syndrome due to germline TP53 mutations. The R337H mutation is especially common in southern Brazil, where pediatric ACT incidence is significantly higher.
Children’s adrenocortical tumors differ from adult tumors in their pathogenetic mechanisms, genomic profiles, and prognosis. They likely derive from fetal adrenal tissue and commonly display loss of heterozygosity of the 11p15 region, leading to IGF2 overexpression. SF-1 gene amplification or overexpression is also common in pediatric cases.
Interestingly, children with adrenocortical tumors generally have better overall survival rates compared to adults with similar conditions. However, the rarity of these tumors makes diagnosis challenging, and symptoms often include virilization, Cushing’s syndrome, or a combination of both. Surgical intervention remains the primary treatment, with complete resection offering the best chance for cure.
Pheochromocytomas and Paragangliomas: Adult vs. Pediatric Presentation
Pheochromocytomas and paragangliomas (PPGLs) are catecholamine-producing tumors that present differently in children compared to adults. Research involving 748 patients (including 95 children) revealed that pediatric cases have significantly higher rates of hereditary tumors (80.4% vs. 52.6% in adults), with mutations affecting hypoxia pathways being particularly common in children.
Children with PPGLs are more likely to develop extra-adrenal tumors (66.3% vs. 35.1% in adults), multifocal tumors (32.6% vs. 13.5%), metastatic disease (49.5% vs. 29.1%), and recurrent disease (29.5% vs. 14.2%). These differences reflect the earlier presentation of disease in children and highlight the importance of comprehensive genetic testing in pediatric cases.
The predominance of noradrenergic tumors in children (93.2% vs. 57.3% in adults) leads to different symptom profiles. While adults often present with the classic triad of headaches, sweating, and palpitations, children may show more varied symptoms including hypertension, visual disturbances, and growth issues. This makes diagnosis particularly challenging and underscores the need for specialized endocrine care.
Can Adrenal Problems Cause Dizziness and Other Common Symptoms?
Adrenal disorders across all age groups can indeed cause dizziness, particularly when standing (orthostatic hypotension), due to impaired regulation of blood pressure. In adrenal insufficiency, insufficient cortisol and aldosterone production leads to sodium loss, potassium retention, and decreased blood pressure—all contributing to dizziness, lightheadedness, and even fainting.
Beyond dizziness, adrenal dysfunction commonly causes fatigue, weight changes, and mood disturbances. Patients with Cushing’s syndrome (excess cortisol) may experience weight gain centrally, muscle weakness, and mood swings, while those with Addison’s disease (primary adrenal insufficiency) typically present with weight loss, fatigue, salt cravings, and hyperpigmentation.
Hormonal imbalances from adrenal disorders can also affect sleep patterns, immune function, and metabolic processes. Diagnosis requires comprehensive testing including morning cortisol levels, ACTH stimulation tests, and imaging studies of the adrenal glands. At Mountain View Surgical, we work closely with endocrinologists to ensure accurate diagnosis before recommending surgical intervention for adrenal conditions.
Adrenal Function and Health in Older Adults
Adrenal function naturally changes with age, with dehydroepiandrosterone sulfate (DHEAS) levels decreasing significantly in older adults. Research has shown that low DHEAS levels in men over 50 (<140 μg/dL) correlate with higher cardiovascular mortality risk. In fact, each 100 μg/dL increase in DHEAS was associated with a 36% reduction in all-cause mortality and 48% reduction in cardiovascular mortality after adjusting for multiple risk factors.
Elderly patients with adrenal insufficiency present unique diagnostic challenges, as symptoms may be attributed to aging or comorbidities. Fatigue, weakness, and orthostatic hypotension—common in adrenal insufficiency—are often misdiagnosed as age-related conditions. Additionally, many older adults take medications that can affect the hypothalamic-pituitary-adrenal axis, further complicating diagnosis.
Treatment of adrenal disorders in geriatric patients requires careful medication management, as older adults may be more sensitive to glucocorticoid side effects including osteoporosis, hypertension, and glucose intolerance. Regular monitoring of bone density, blood pressure, and metabolic parameters is essential for elderly patients on long-term steroid replacement therapy.
Surgical Management at Mountain View Surgical Associates
At Mountain View Surgical Associates, our experienced surgeons Dr. Michael R. Snyder and Dr. Lisa Peters specialize in minimally invasive approaches to adrenal gland disorders. For patients with adrenocortical tumors, pheochromocytomas, or other conditions requiring surgical intervention, we utilize advanced laparoscopic and robotic techniques that result in smaller incisions, less pain, and faster recovery.
Our comprehensive approach begins with thorough preoperative assessment and coordination with endocrinologists to ensure optimal hormonal management before, during, and after surgery. For patients with Cushing’s syndrome, careful preoperative preparation is essential to minimize complications. Similarly, patients with pheochromocytoma require specialized alpha-blockade before surgery to prevent dangerous blood pressure fluctuations.
The surgical team at Mountain View Surgical understands the unique considerations for pediatric, adult, and geriatric patients with adrenal disorders. We tailor our approach to each patient’s specific needs, whether performing a delicate adrenalectomy on a child with an adrenocortical tumor or a complex procedure on an elderly patient with multiple comorbidities. Our goal is to provide exceptional surgical care while minimizing risks and optimizing outcomes for patients throughout Parker, Castle Rock, Lone Tree, Centennial, and Frisco, Colorado.
To learn more about our specialized approach to adrenal disorders or to schedule a consultation, contact Mountain View Surgical Associates today. Our team is committed to providing exceptional care for patients of all ages with adrenal conditions requiring surgical intervention.
