Conditions we treat
The pituitary gland at the base of the brain and the adrenal glands on top of the kidneys work together to regulate stress hormones, blood pressure, metabolism, growth, and reproduction. When either gland makes too much or too little of a hormone, symptoms can be vague and easy to miss: fatigue, weight changes, hard-to-control blood pressure, or irregular periods. These conditions are less common than diabetes or thyroid disease, and the hormone testing involved is complex and timing-sensitive, which makes an endocrinologist’s evaluation especially valuable.
5–14%
of people with high blood pressure seen in primary care have primary aldosteronism
About 40%
of pituitary tumors are prolactinomas, the most common type
8 in 10
cases of Cushing’s syndrome not caused by medicines are due to ACTH-producing pituitary tumors
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Common reasons people are referred to an endocrinologist include:
Including Addison's disease: the adrenal glands don't make enough cortisol, and sometimes aldosterone
Too much cortisol, most often from long-term, high-dose glucocorticoid medicines, or from a pituitary or adrenal tumor
Excess aldosterone that raises blood pressure and can lower potassium
Rare tumors that release adrenaline-like hormones
Adrenal nodules found by chance on a CT or MRI scan done for another reason
Including prolactinomas, growth hormone-producing tumors (acromegaly), and non-functioning tumors
Symptoms depend on which hormone is affected, and they often overlap with more common conditions:
Fatigue, muscle weakness, loss of appetite, weight loss, abdominal pain, dizziness on standing, and salt craving
Weight gain around the trunk, a round face, thin arms and legs, easy bruising, wide purple stretch marks, and muscle weakness, often with high blood pressure or blood sugar
Often no symptoms other than high blood pressure, which may be hard to control
Episodes of headache, sweating, and a pounding heartbeat
Headaches, loss of side (peripheral) vision, milky nipple discharge, irregular or absent periods that can resemble PCOS, low sex drive, or enlarged hands and feet in acromegaly
Extreme thirst and large amounts of dilute urine
Accurate diagnosis depends on choosing the right test and timing it correctly. Adrenal insufficiency is evaluated with early-morning cortisol and ACTH levels and often an ACTH (cosyntropin) stimulation test. For Cushing’s syndrome, the NIDDK describes three main tests: a late-night saliva cortisol test, a 24-hour urine cortisol test, and an overnight dexamethasone suppression test.
Primary aldosteronism is screened with aldosterone, renin, and potassium levels, and the Endocrine Society’s 2025 guideline suggests this screening for everyone diagnosed with high blood pressure. Pheochromocytoma is tested with plasma or urine metanephrines. Pituitary evaluation may include prolactin, IGF-1, and other hormone levels, a pituitary MRI, and visual field testing. Because steroids, estrogen, and some blood pressure medicines can affect results, bring a complete medication list to your visit.
Many adrenal and pituitary conditions are very treatable, and options depend on the cause:
Lifelong hormone replacement, usually hydrocortisone, plus fludrocortisone for Addison's disease, with extra "stress doses" during illness or surgery
Carefully tapering glucocorticoid medicines when they're the cause, or surgery to remove a pituitary or adrenal tumor; medicines and radiation are options when surgery isn't possible or doesn't fully work
When one adrenal gland is responsible, often confirmed with adrenal vein sampling, surgery may be an option; otherwise, medicines such as spironolactone or eplerenone block aldosterone's effects
Usually treated first with medicine, such as cabergoline or bromocriptine
Surgery by an experienced pituitary surgeon, sometimes followed by medicine or radiation, plus replacement of any hormones the pituitary no longer makes
Adrenal crisis is a life-threatening emergency that can occur when cortisol is severely lacking, especially during illness, injury, or surgery. According to the NIDDK, it can cause dangerously low blood pressure, low blood glucose, low sodium, and high potassium. Warning signs include severe weakness, vomiting, abdominal pain, confusion, or fainting. If you have adrenal insufficiency, use your emergency injection and call 911.
Never stop long-term glucocorticoids such as prednisone suddenly. After extended use, the body’s own cortisol production may be suppressed, and stopping abruptly can cause adrenal insufficiency. Always taper under medical guidance.
Adrenal and pituitary care often involves several steps. Your endocrinologist plans testing in the right order, including any medication adjustments and early-morning or dynamic tests, then interprets results in the context of your symptoms and imaging.
When surgery, radiation, or specialized imaging is needed, we coordinate with neurosurgeons, endocrine surgeons, radiologists, and eye specialists, and keep your primary care doctor informed. We also provide written sick-day plans for people on steroid replacement. Follow-up lab reviews can often be virtual, while dynamic testing is done in person. Request a consultation to discuss your results.
Cushing’s syndrome is the general term for having too much cortisol, whatever the cause, including glucocorticoid medicines. Cushing’s disease is one specific cause: a pituitary tumor that makes too much ACTH, which signals the adrenal glands to overproduce cortisol. According to the NIDDK, these pituitary tumors cause about 8 out of 10 cases not due to medication.
The Endocrine Society’s 2025 guideline suggests that everyone diagnosed with high blood pressure have aldosterone, renin, and potassium levels checked. Primary aldosteronism is common, often missed, and raises the risk of heart and kidney problems, yet targeted treatment is available. Ask your clinician whether screening makes sense for you, especially if your blood pressure is hard to control.
Almost all pituitary tumors are benign adenomas, not cancer. They are fairly common, and many never cause problems. Some, however, produce excess hormones or grow large enough to press on nearby nerves and affect vision. An endocrinologist can determine whether a tumor is hormonally active and whether it needs treatment or simply monitoring.
“Adrenal fatigue” is not a recognized medical diagnosis, and endocrine experts caution against it. Persistent fatigue deserves a proper evaluation, because it can reflect true adrenal insufficiency, thyroid disease, anemia, sleep problems, depression, or other conditions. Unregulated “adrenal support” supplements can contain hormones and may cause harm, so talk to your clinician before taking them.
If you have taken prednisone or another glucocorticoid for more than a few weeks, your adrenal glands may have reduced their own cortisol production. Stopping suddenly can lead to adrenal insufficiency, with fatigue, nausea, dizziness, or, in severe cases, adrenal crisis. Always follow a tapering plan from your clinician, who may check your cortisol levels along the way.
Last reviewed September 19, 2026. This page is educational and is not a substitute for personal medical advice — see our medical disclaimer.
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