What are Adrenal Symptoms?
There are many symptoms associated with the adrenal gland which are related to the over-production or under-production of the adrenal hormones. Over-production of adrenal hormones is usually due to an abnormal growth of one of the adrenal glands and the symptoms that appear depend on which hormone is being made in excess. Most commonly these symptoms come from a benign adrenal gland tumor, and removing the tumor with a Mini Back Scope Adrenalectomy (MBSA) can usually resolve the hormone excess. Under-production of adrenal hormones (adrenal insufficiency) is much less common and causes fatigue, weakness, weight loss and low blood pressure. This website discusses adrenal tumors and adrenal surgery in great detail. Dr. Carling is one of the world's most experienced adrenal surgeons.When you have an adrenal tumor, you can have numerous symptoms. Because most doctors see only a handful of adrenal tumors during their careers, they may not have much experience with them. Thus, it is very important for patients to know about the symptoms of adrenal tumor disease. A great doctor will always perform a very careful history and physical examination to identify signs and symptoms of adrenal tumor disease.
High Blood Pressure Symptoms. One of the hallmarks of adrenal tumors is high blood pressure, also known as hypertension. Tumors that overproduce catecholamines (called pheochromocytoma), as well as aldosterone-producing tumors (causing primary aldosteronism, also called Conn's syndrome) and cortisol-producing tumors (causing adrenal hypercortisolism) can all cause high blood pressure. Read more about high blood pressure and adrenal tumors.
Symptoms of High Aldosterone: Primary Aldosteronism (Conn's Syndrome)
Signs and symptoms of primary aldosteronism (primary hyperaldosteronism, Conn’s syndrome): Many patients feel normal (asymptomatic) except for high blood pressure. The symptoms, if present, can be variable.
If the adrenal gland is overproducing aldosterone, then you have a disease called primary aldosteronism (PA), also called primary hyperaldosteronism, Conn's syndrome or Conn syndrome after Dr. Conn, who first described this disease. The main sign of PA is high blood pressure. Some patients also have low potassium in the blood, which can cause muscle cramps, weakness, frequent urination and heart palpitations (feeling your heart racing). Low potassium is not required, however: most patients with PA have a normal potassium level. Everyone with high blood pressure should be screened for PA with a simple blood test for aldosterone and renin (the aldosterone-to-renin ratio), as recommended by the 2025 Endocrine Society guideline. We have an entire section of this website dedicated to the diagnosis and treatment of PA.
Almost all patients with PA have high blood pressure. PA is especially likely if your high blood pressure started when you were relatively young, needs several medications to control, or comes with low potassium, sleep apnea or atrial fibrillation, but anyone with high blood pressure can have it. It is important to know that many patients with PA are asymptomatic. They don’t have any significant symptoms. They may feel normal and the only sign may be high blood pressure. However, if PA is not treated, patients have about 2.5 to 4 times the risk of stroke, 2.6 to 6.5 times the risk of heart attack and 3.2 to 12 times the risk of atrial fibrillation compared with people who have ordinary high blood pressure of the same severity.
How Common is Primary Aldosteronism (Conn's Syndrome)? PA is much more common than you would think--with most people undiagnosed. It affects an estimated 5–20% of people who have high blood pressure (hypertension), yet fewer than 1% of cases are diagnosed, and thus all doctors should be on the lookout for it. It is very important to identify these individuals. When one adrenal gland is responsible, an operation (adrenalectomy; Mini Back Scope Adrenalectomy, MBSA) cures the aldosterone excess in the large majority of patients. Blood pressure becomes completely normal without medication in roughly a third to a half of patients and improves in most of the rest, and the risk of dying prematurely from heart disease and stroke can be reduced. Mild PA and PA that comes from both adrenal glands often respond well to medication (spironolactone or eplerenone). Because 13–27% of patients with PA also make excess cortisol, every patient with PA should have a 1-mg dexamethasone suppression test.
Symptoms of High Cortisol: Adrenal Hypercortisolism (AHC, MACS, Cushing Syndrome)
Severe adrenal hypercortisolism (Cushing syndrome) causes many symptoms throughout the body.
If the adrenal tumor is overproducing cortisol, you have adrenal hypercortisolism (AHC), formerly called MACS (mild autonomous cortisol secretion) or subclinical Cushing syndrome. Severe AHC is also called adrenal Cushing syndrome. The symptoms of severe AHC include weight gain and central body obesity (you store fat especially around your abdomen). Your face might develop more round features and you develop fat deposits above your collar bones and on your back (called buffalo hump). Patients may develop problems with bruising easily, thin skin and poor wound healing.
Other symptoms of excess cortisol production from the adrenal gland include stretch marks on the skin that tend to be purple (often on the abdomen) and muscle weakness in your extremities (arms and legs). It can also affect how you feel and how your brain works. Excess cortisol can cause depression and anxiety symptoms. It can cause hirsutism (facial hair growth) in some women. Many patients with AHC have high blood pressure (hypertension) and weak bones (osteopenia and osteoporosis, sometimes with fractures). The blood sugar may be increased, and patients can even develop diabetes. Some patients with severe AHC also have low potassium and high white blood cell (WBC) counts. See our page on the symptoms of adrenal hypercortisolism for more detail.
Do all patients with excess cortisol production have symptoms? Actually, they do not. Most patients with adrenal tumors that overproduce cortisol do not have the classic Cushing appearance and have no obvious symptoms. These patients used to be described as having subclinical Cushing syndrome or MACS. But "subclinical" and "mild" describe a lab value, not the effect on your health: even without the classic appearance, AHC is linked to high blood pressure, diabetes, bone fractures, heart disease and earlier death. An astute doctor will recognize that when a patient has slight to obvious obesity, hypertension, hyperglycemia (high blood sugar), pre-diabetes or frank diabetes mellitus, this can be due to AHC. This constellation of signs and symptoms is often referred to as metabolic syndrome. The key test is simple: a 1-mg dexamethasone tablet late in the evening and a blood cortisol the next morning. A cortisol above 1.8 µg/dL is abnormal. A result of 1.2–1.8 µg/dL is possible AHC, which must be interpreted together with ACTH and DHEA-S and is worth repeating.
It is very important to identify patients with AHC, whether mild or severe. Adrenalectomy (usually a Mini Back Scope Adrenalectomy, MBSA) is the only cure and the first-line treatment. It can improve the patient’s quality of life, improves or resolves high blood pressure and high blood sugar in many patients, and may lower the risk of dying prematurely from heart disease and stroke. In a randomized trial (CHIRACIC, Lancet Diabetes & Endocrinology 2025), adrenalectomy improved blood pressure control compared with conservative care (46% versus 15% of patients). In mild AHC the decision is individualized, based on your cortisol-related health problems, whether one or both glands are involved, your age, surgical risk and your preference.
Symptoms of Pheochromocytoma: Excess Adrenaline From the Adrenal Medulla
A pheochromocytoma is a tumor growing from the inner part of the adrenal gland (the medulla) and it overproduces fight-or-flight hormones (catecholamines: adrenaline, also called epinephrine; noradrenaline, also called norepinephrine; and sometimes dopamine). Thus, the symptoms of a pheochromocytoma are the symptoms of panic and anxiety. Of note, a paraganglioma is a tumor similar to a pheochromocytoma, but it arises from the same cell type outside the adrenal gland, for instance, along the major vessels of the abdomen, in the chest and neck. Paragangliomas can cause similar symptoms. Many pheochromocytomas are now found by chance on a scan or through genetic testing before they cause any symptoms. About 30–40% are hereditary, so genetic testing should be offered to every patient.
Signs and symptoms of Pheochromocytoma and Paraganglioma. The symptoms can be very variable, and some patients are asymptomatic.
Catecholamines are the hormones involved in our fight-or-flight mechanism. If you ever remember getting scared you can probably remember your heart racing and beating very hard and your face flushing or getting very pale (pallor) and sweating. This is the function of the fight-or-flight hormones of the adrenal gland. These hormones are produced in the medulla (core; inner layer) of the adrenal gland.
Symptoms of pheochromocytomas often come and go. Many patients with a pheochromocytoma have a variety of symptoms. They can have spells that are extremely variable with differing symptoms each time, but the symptoms typically include heart palpitations, pallor, flushing, tremors, headaches and sweating. In other words, patients feel a sudden surge of panic, with anxiety and a feeling of impending doom. They get sweaty and their heart races.
The symptoms may be completely spontaneous but are sometimes precipitated by a change in posture, anxiety, certain medications or maneuvers that increase the intra-abdominal pressure (for instance going to the bathroom). The physical signs when you examine patients with pheochromocytoma may include hypertension, which may occur just occasionally (paroxysmal) or be sustained, as well as orthostatic hypotension (meaning the blood pressure drops when you stand up). Patients may develop tremors, pallor or in extreme cases, even retinopathy (damage to the retina of the eye), fevers, cardiogenic (heart) shock and heart failure. We have an entire section of this website dedicated to the diagnosis and treatment of pheochromocytomas, including a page on pheochromocytoma symptoms.
Symptoms of Adrenal Cancer
Adrenocortical cancer (ACC) can cause many symptoms. Common symptoms are due to a "mass effect", which simply means the tumor is growing big so it pushes on surrounding structures and organs in the abdomen. This can manifest itself as flank or abdominal pain or as an increase of girth (a growing waistline). Fluctuations in weight can also be seen, both weight loss and weight gain.About half of all adrenocortical cancers overproduce cortisol. Thus, patients can develop signs and symptoms of severe cortisol excess (see the symptoms of high cortisol above), often coming on quickly.
Adrenocortical cancer can also overproduce sex steroid hormones (androgens and estrogens). In women, increased androgen can lead to hirsutism (development or increase of facial hair), acne, absence or changes in the menstrual cycle and increased libido (sex drive). In men, increased estrogen can cause gynecomastia (enlarged and tender breasts), problems with libido (sex drive) and erectile dysfunction.
If you have an adrenal tumor and overproduction of sex steroid hormones, this often occurs in the setting of a cancerous tumor, so that is very important to know. Aldosterone-producing adrenocortical cancer, although rare, can lead to signs and symptoms of primary aldosteronism (see the symptoms of high aldosterone above). Patients with adrenocortical cancer can also be completely asymptomatic, or have only hypertension, osteoporosis, diabetes or low potassium. We have an entire section on the diagnosis and treatment of adrenal cancer.
Last updated October 2026.