The Adrenal Glands
Friday 9 August 2019
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My Amazing Body is a podcast where we explore interesting, unknown and misunderstood parts of your body with help from medical experts and stories from real Queenslanders.
This episode is all about the adrenal glands. Dr Tom Dover explains what the adrenal glands are, how they work and how they affect your day-to-day life. He also explains conditions that can affect the adrenal glands, including Addison’s disease and Cushing’s syndrome. We learn how Queenslander Natalie’s physical and mental symptoms of a fear of public speaking stem from the adrenal glands, and Inspector Corey Allen from Queensland Police Service explains how he takes the fight or flight response, driven by the adrenals, into account when training new police recruits.
Meet our guests
Dr Tom Dover is an endocrinologist working at Ipswich Hospital and the Ipswich Indigenous Health Centre.
Inspector Corey Allen teaches new police officers about how the fight or flight response may affect them on the job.
Queenslander Natalie talks about her fear of public speaking, a common trigger of the fight or flight response.
Audio is great, but some things are best seen as well as heard, or might tempt you to do further reading. These materials provide more information about topics we touch on in the show.
The adrenal glands - diagrams
Cushing’s syndrome and Addison’s disease
Cushing’s syndrome and Addison’s disease are two serious conditions that can affect the adrenal glands and how they work. More information about Cushing’s syndrome and Addison’s disease can be found at the links below.
Do you find yourself getting red in the face when you have to speak in public like Natalie? You can read more about this bodily reaction at the links below.
In the podcast, Dr Dover explains that ‘adrenal fatigue’ is not an accepted medical diagnosis, and people self-diagnosing or being told they have adrenal fatigue by health professionals could prevent them from receiving a diagnosis of a different medical issue. For more information about why adrenal fatigue isn’t recognised as a medical diagnosis, and what might be causing symptoms like tiredness, you can visit Health Direct.
Natalie: Some of the things that happen to me physiologically are I will shake a little bit. Not a lot, but my hands will shake. Sometimes I get sweaty palms.
Host: That's Natalie. She's talking about what happens when she has to speak in public.
Natalie: I will actually get a rash on my chest and my arms. My brain is in overdrive, so the self talk is going a 100 mile an hour. And, my voice shakes. I don't think other people can hear that as much as I can, but my voice definitely shakes. And often I feel it crack when I'm actually talking.
Host: Fear of public speaking is called glossophobia. Some studies show that for around a quarter of the population, it's their number one fear, even scarier than death. Like Natalie, people report shaking hands, an upset stomach and excess sweating when they are forced to speak in public. But what's causing all these physical reactions? Listen on to find out.
Hi, I'm Elise. Welcome to the latest episode of My Amazing Body, where we explore interesting, unknown and misunderstood parts of your body. Today, we're learning all about the adrenal glands.
Dr Tom Dover is an endocrinologist who works in Ipswich for West Moreton Hospital and Health Service. He spoke with us about what the adrenal glands are, the important role they play in our health, and how they get involved in Natalie's response to public speaking.
Dr Dover: The adrenal glands live on top of the kidneys. We have two kidneys and two adrenal glands and they're like hats on the kidneys. They only weigh about four to six grams, but very important.
Host: Along with other hormone-producing glands, the adrenal glands are part of the body's endocrine system.
Dr Dover: We have other glands that are also part of this system. We have the thyroid, we have the adrenals, testicles and ovaries, amongst other glands.
Host: For each of these glands there is a master gland monitoring levels of hormones in the body and telling them what to do. Dr Dover says for the adrenals, the pituitary gland in the brain is the boss.
Dr Dover: In this particular example, the pituitary talks to the adrenal, tells it to make cortisol and then those levels are regulated in the body. If the adrenals aren't making enough cortisol, the pituitary or the boss will start raising its voice.
Host: When you think about what hormones the adrenals produce, you probably immediately think of adrenaline. But the adrenal glands are responsible for a range of hormones, which all play important roles in your body.
Dr Dover: They make many, many hormones that control many body functions. This includes, they regulate your salt and water balance. They control your cortisol levels, which is a stress hormone. They make some androgens, which are male hormones and the inner part of the adrenals also make very commonly known hormones like adrenaline. Most of us are very familiar with adrenaline in that particularly that fight or flight response, the racing heart, the sweaty and shaky that you get when you're startled or shocked or under stress.
Host: Dr Dover says these hormones go on to effect different parts of your body, interacting with other organs and systems.
Dr Dover: For example, one hormone called aldosterone is made by the adrenal, but it works on the kidney and tells the kidneys to retain or hang on to salt and water and a number of other hormones that also work there.
Host: Interested in how the kidneys and adrenals work to manage your salt and water balance? Tune in to episode 8, which is all about the kidneys.
The human body's fight or flight response is driven by the adrenal glands and the hormones they release. If a great big lion suddenly appears out of the grass, your body is primed by the adrenals to either fight it off or run away as fast as you can. Dr Dover explains how this works.
Dr Dover: When you get shocked, there's an automatic firing of nerves through a part of the nervous system called the sympathetic nervous system that, all of a sudden before you even know it, has stimulated the inner part of the adrenal. It squirts out a whole lot of adrenaline and these other hormones. Now they act very, very quickly and they don't last very long. But, from evolutionary terms, if you heard that lion roar, you're going to get out of there as fast as you can.
Host: These days, we don't run into threats like lions all that often. But situations like public speaking, which some people like Natalie find really scary, still trigger the fight or flight response.
Dr Dover: Yeah, I think the stressors have probably changed a little bit from the acute I'm going to dire stress to that more day to day stress. Your boss isn't happy with you. There're problems at home, there're financial problems. The symptoms people get are very similar, you can get that racing heart, you can get the sweaty hands, you don't think straight, you can get shaky. All these things are signs that your body is under stress and that your adrenaline and those other hormones I've mentioned are slightly elevated.
Host: For Natalie, one of the most obvious physical signs of this stress is a red blush that can spread up her arms, her neck and her face when she has to speak in front of others.
Natalie: My chest will break out in a rash essentially. It looks like a rash. It's not, because I'm told what it actually is my capillaries expanding, and the blood coming to the surface of my skin. But the location of that rash is from my chest, lower middle chest, up to the very top of my neck. So even if I wear a high neck dress or top, it still creeps up the longer I'm up on stage or in front of people. And it also comes down the side of my arms sometimes.
Host: Natalie's red skin is caused by adrenaline, which makes the capillaries in her skin expand and draw more blood to the surface. Even though logically Natalie knows she's not in any real danger, her fight or flight response is priming her body to either protect herself or flee the stressful situation.
Natalie: I suppose I work myself up more than I really should or need to, and something sort of goes on in my brain that I can't control that tells me that there's danger or it's a scary situation when it's actually not. My logical brain doesn't take over and tell me to calm down. There's something actually happening in my brain that's telling me it's a scary situation and that I should be nervous.
It can be anything from even just introducing yourself in a meeting, in a group of people that you haven't really met or engaged with before. As it's going around the table where everybody's just doing that little introduction about themselves, I can actually feel my body having a sort of physiological reaction in the lead up to it being my turn.
Host: Are you ready for this episode's mystery body part? See if you can guess the body part from the clues given. We'll reveal the answer at the end of the episode.
If you hit me it might really hurt, because of my numerous nerve-ending receptors. Most people have ten of me, though it is not abnormal for people to be born with up to thirteen, which is known as polydactylism. In a set of ten, the two largest carry most of your load, in fact, almost twice as much as all the other ones combined. I provide balance and support when you walk, maintaining contact with the ground 75% of the time. What am I?
Inspector Allen: My name's Corey Allen, I'm an inspector with Queensland Police Service. I am in charge of operational training services. So, basically I'm in charge of all the skills and weapons and tactics and physical training that police do both as recruits and in service when they're sworn members out in the community.
Host: Inspector Allen spends his days training Queensland Police Officers to deal with hormones like adrenaline in their day-to-day work. For police officers, understanding how their body reacts to fight or flight situations could be a matter of life or death for them, and for the members of the public they're working with.
Inspector Allen: Police's reactions to the things that they see both psychologically and physically are extremely important, not only because it can affect that individual's wellbeing, the police officer themselves and how they might be healthy or unhealthy after something happens, but in how the police make decisions about what happens when they're in that state.
Host: Before they hit the streets, Inspector Allen puts officers through training to help them understand how hormones like adrenaline will affect their body when they're on the job.
Inspector Allen: So, we try to expose police in their training, especially in their initial training to what that feels like and how to deal with it and give them skills and tactics that help get a better outcome. So, for example, we train recruits on how to use their firearm. So, using a firearm itself is difficult and it's a complex fine motor skill performed under stress, but it's much more than that when you do it operationally, because it's not only just learning how to use a piece of equipment, it's learning how to make a decision about that, which is by far the most complex part at a time when your brain's not working in its complex state, it's working in a very primal state.
So, what we do is we expose them gradually to those types of conditions. We get them adrenalised, we get their heart rate and their respiratory rate up. And then we put them in those immersive scenario situations and we coach them through the scenarios to get a better response so that when they confront something out on the street, it won't be the first time, it won't be a shock.
Host: Inspector Allen says it's important for police officers to understand how hormones like adrenaline will affect their body and their mind when they're working.
Inspector Allen: Well, it does promote certain physical attributes that help police physically do their job better. The downside to that is if you're not used to what's happening, there are other physiological factors that come into play that can make your job more difficult. So, a person under stress, when their body produces a lot of adrenaline and all those other wonderful biological chemicals that do good things, also suffer from auditory exclusion where they can't hear what happens as clearly as they would normally hear because they're in stress. They also have tunnel vision, so they can't see their peripheral vision like they used to. And we've since found out that they have something else called flashbulb memory where they'll remember small pieces of something when they're under stress, but they won't remember everything as perfectly as if they were in a calm state.
Host: Managing their fight or flight reaction starts from the minute an officer get the call to attend a situation. While police movies might make high-speed dashes to an emergency situation look thrilling, Inspector Allen explains that he actually trains police to not get too amped up when driving to a job.
Inspector Allen: Instead of driving at speed to get somewhere too fast and putting yourself at risk and being over-adrenalised, we teach police to ... urgent duty driving and driving skills is part of my area. So, we teach police to drive in a way that gets them there quickly, without being dangerous, without over stimulating them as well.
Host: Inspector Allen clearly recalls the effect of adrenaline on his body when attending dangerous situations as a police officer and uses this knowledge to help train new recruits. Just a warning for our listeners, this story from Inspector Allen does include references to domestic violence. If it triggers issues for any of our audience we’ve included links to support services on in our show notes.
Inspector Allen: I remember as a young police officer at mobile patrols, we'd gone to a very bad domestic disturbance where a woman had been hurt with a knife and she was on the floor rocking backwards and forwards. And when I looked to my left, this fellow who had hurt her had a knife in his hand. And he looked like he meant business.
So, I remember things slowing down for me, and I remember feeling oddly comfortable that things had slowed down. And even though what happened in a very short period of time didn't take that long, it took a long time for me. I remember thinking, "Wow, that's really interesting. This whole thing has slowed down almost like I'm moving in glue." And fortunately, the man put the knife down and we took him into custody. And I remember my partner saying how relieved he was that I reacted well because I was only new in the police.
And I remembered straight afterwards I didn't really recall a lot of what happened. I could see pieces of it, which now I know is that flashbulb memory. But a couple of weeks after when I had to write a statement and had to do those things that I could recall greater detail, which is something we know now, that you don't recall much straight after, but your memory kind of fills in the little pieces afterwards.
Host: Even if you're not in a job that sees you attending daily emergencies like a police officer, Dr Dover says it's important to be mindful of stress and the effect it can have on your wellbeing.
Dr Dover: Stress and anxiety is associated with high blood pressure and is a risk factor for heart disease, diabetes, amongst other conditions. It's very important to manage that in the long run and addressing the individual factors that are causing the stress and anxiety. So, simple things people can do - talking therapy, having a good network of family, friends, a general practitioner, or a counsellor is very effective. Exercise is just as effective as that, incorporating some daily exercise into your routine. Getting sun is very important. It can help our reset your sleep wake cycle if people are having trouble sleeping at night. We also have medical therapy, there are some tablets that are anti-anxiety, anti-depressant, that work very well. But, ideally a combination is the best way forward.
Host: When it comes to conditions that affect the adrenal glands, Dr Dover says it's hard to overwork the tiny organs, but that there are conditions that might change how well they function. Cushing's syndrome causes the adrenal glands to make too much cortisol, which has a range of effects on a person's health.
Dr Dover: You can have an overactive adrenal specifically that medical condition is called Cushing's. That's where either the adrenal gland has a tumour that's making too much cortisol or earlier I mentioned the pituitary gland, the big boss upstairs, that can develop a tumour that stimulates the adrenal glands. The other ways people can make too much cortisol, one, if they're taking Prednisone or Dexamethasone, or tablets containing cortisol.
It is difficult to tease out, particularly if they're making too much cortisol in a condition called Cushing's Syndrome. It is rare, but as a specialist in the field, we do see it not uncommonly. If the adrenal glands aren't making enough cortisol, the symptoms are more profound. People tend to lose weight and they get very dizzy, lightheaded, they can develop abdominal pain and depending on what the cause of it is, they can actually become very tanned.
Host: And what about if you're adrenal stop working altogether, or aren't making enough cortisol? Dr Dover says the consequences can be dire.
Dr Dover: You actually die without your adrenals. Particularly, there's one hormone called cortisol and there's a condition called Addison's disease. That way the body doesn't make cortisol, and if it's not picked up early enough, people die. We manage that commonly in our endocrine clinics. It's a very important hormone for regulating blood pressure amongst other things. Also, stress response when we get sick, our cortisol levels go up to help us fight the inflammation and infection.
Host: Have you ever heard of 'adrenal fatigue'? It's a popular phrase right now, with internet wellness gurus talking about how it can cause everything from over-tiredness to bad skin and sharing methods to treat the problem. We asked Dr Dover, is adrenal fatigue a real thing?
Dr Dover: Adrenal fatigue is not a medical condition, unfortunately it's a totally made up condition that was first mentioned in 1998 by a chiropractor to try and explain a group of symptoms of tiredness, no energy, poor sleep. Adrenal fatigue is actually a combination of terms that don't make sense if you understand the basics. Adrenal fatigue, the way it's explained, is that the adrenal glands over a long period are very stressed and making too much cortisol and then after a while they stop making cortisol and thus the adrenal fatigue.
Now, I have had many referrals for adrenal fatigue. We assess the adrenals to see if they're making enough cortisol and they all are. I also assess them to see if they're making too much cortisol and they also are making normal amounts of cortisol. It's normally a combination of factors such as people being overweight, a lot of stress in their life, possibly sleep apnoea. Many, many conditions or lifestyle factors contribute to the symptoms and it's not the adrenal.
Host: Self-diagnosing things like 'adrenal fatigue' can cause people to miss out on being diagnosed with and receive treatment for serious health conditions. If you're concerned about any changes or symptoms you've noticed in your body, it's important to see a health professional like your GP, rather than Dr Google.
Even though 'adrenal fatigue' isn't a condition, Dr Dover does have some advice for Queenslanders wanting to look after their adrenal glands and their endocrine system as a whole.
Dr Dover: To help the adrenal gland because it's part of a slightly more complex system, it talks to the kidney, and the brain talks to it and it regulates all these hormones. It really comes down to basics. Getting good sleep is very important. I've mentioned how cortisol drops down overnight. If you're getting poor sleep, if you have sleep apnoea or conditions impacting on your sleep. I have a five-month-old girl at the moment, so my cortisol levels are spiking during the night. That's going to impact on how you feel. Watching your weight is very important, to controlling things like blood pressure, which are regulated by the adrenal glands as well. Diet and salt is very important.
I've mentioned the aldosterone hormone, it regulates salt and water balance. We want to make sure that we're watching our sodium intake. Drinking plenty of water. Exercise is super important in keeping the body healthy, controlling weight, controlling blood pressure, and preventing cardiovascular disease.
Host: Dr Dover says that Queenslanders should pay attention to all the medications and supplements they're taking and talk to their doctor or pharmacist if they have questions about how the ingredients could affect their endocrine system.
Dr Dover: There are some medications, which also impact on this. I've mentioned the prednisone, and we don't like people being on that for too long. It can cause the adrenal glands to get a bit tired, making cortisol. The inhaled puffers for asthma contain inhaled corticosteroids, so we like people being on the lowest possible dose of that. Opioids, so codeine and morphine related medications or oxycontin et cetera, can also impact on the pituitary gland in the brain, which can impact on the downstream organs like the adrenal.
Natural therapies, once again, it's one of those misnomers that you call it 'natural', but sometimes these do contain products; royal jelly is does contain some cortisol in a different form. There's some other natural therapies that contain some of these compounds as well. You do have to make sure you read the labels and question exactly what you're on.
Host: Whether you get shaky before public speaking or you're in a high-stakes job, your adrenal glands play a big role in your overall health. Dr Dover is passionate about the endocrine system, and how it can affect a person's overall wellbeing.
Dr Dover: The endocrine system is by far the most interesting. If there's anybody in doctors out there definitely become endocrinologists.
Host: Thanks for listening to this episode of My Amazing Body. Before we go, did you guess this episode's mystery body part? Your ten, nerve-filled load bearers are of course, your toes! Did you guess correctly?
My Amazing Body is brought to you by Queensland Health. With special thanks to our expert guest Dr Tom Dover, Inspector Corey Allen and the Queensland Police Service, and Natalie, for agreeing to speak on our podcast even though it was all about her fear of public speaking. Thank you to my podcast colleagues - Lauren our researcher, writer and producer, Carol our audio technician, Helen on sound effects and Dan our music guru. Special thanks to the media team at West Moreton Hospital and Health Services.
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