Dr. Michael Tamber joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about adrenal gland disorders.
Read the transcript of Dr. Tamber's talk on adrenal gland disorders or listen here
Health Matters: Joining us from The Everett Clinic (they have fine doctors there) is Dr. Michael Tamber. He is an endocrinologist, and the topic for our interview is adrenal glands. Health Matters: Hey, tell us. What are the adrenal glands, what do they do, where they're located? Give us all the ins and outs.
Dr. Tamber: Sure. The adrenal glands are really small glands. There is one that sits atop of each kidney, on your flank, on the back. What they do is make a whole bunch of different hormones and it regulates all aspects of how your body works.
Dr. Tamber: The adrenal gland has an inner part called the adrenal medulla, and that's responsible for making the adrenaline-type hormones, what you think about with the fight-or-flight response…Then, you've got the outer part of the adrenal gland which is the adrenal cortex, and that's basically got three layers, and going from outside to inside you're making a hormone that regulates salt, called aldosterone. In the middle, you've got a hormone called cortisol which is regulating blood sugar, metabolism, it's helping to support blood pressure. It does, actually, a lot of things. And then, the most inner layer of the cortex is making the sex steroids, so mostly male-type hormones, androgens.
Health Matters: What are the symptoms of adrenal insufficiency?
Dr. Tamber: Adrenal insufficiency is generally referring to not enough cortisol, and the symptoms of that are often pretty nonspecific, but the ones that we will see probably with more frequency, are severe fatigue, loss of appetite, unintentional weight loss, nausea, vomiting, abdominal pain, diarrhea, sometimes hyperpigmentation of the skin, so basically tanner skin, among many other symptoms…
Health Matters: Why does this happen?
Dr. Tamber: There are a bunch of different things that can cause adrenal problems and cause adrenal insufficiency. One of the things that causes it is an autoimmune process called Addison's, and that's pretty rare, maybe 1 in 100,000 people will get Addison's.
Health Matters: I've heard of that, though. Did John F. Kennedy have Addison's?
Dr. Tamber: Exactly.
Dr. Tamber: What happens is the immune system can attack the adrenal glands and that attack causes the adrenals to not produce enough cortisol, and that leads to the symptoms of adrenal insufficiency that we just talked about. There are many other things that can cause it as well. Tumors, hemorrhage, certain infections…That's all considered primary adrenal insufficiency where the main problem, the primary problem, is with the adrenal gland itself. We've also got secondary adrenal insufficiency where the problem is not with the adrenal glands, which are actually fine. It's that the pituitary gland in the brain, which controls the adrenal glands, is not sending out the proper signal to the adrenals to do what they need to do. Also, when people take steroids long term, like prednisone, the prednisone basically tells the pituitary gland, "Hey, there is enough steroid in the body," because prednisone is sort of like cortisol. So, the pituitary will say, "Okay, there's enough steroid in the body, I am not going to try to stimulate the adrenal glands to make any more." So, essentially, the adrenal glands go to sleep. They atrophy. If you take away the prednisone all of a sudden, you'll have someone who feels pretty sick with all those symptoms of adrenal insufficiency that we just talked about because their pituitary is essentially sleeping as well.
Health Matters: Wow. You know, it's so interesting. If you look at the human body, I mean, how it functions, and that's your job as an endocrinologist, is really all of these hormones and regulatory effects on the body. It's pretty fascinating. You're saying the pituitary gland gives a message to the adrenal gland and your job is to figure out where that loop breaks down.
Dr. Tamber: Right.
Health Matters: We're talking to Dr. Michael Tamber. He's an endocrinologist from The Everett Clinic. We are talking about adrenal glands. Here's what I go so far. Doctors are pretty smart, don't you think?
Health Matters: Well, these endocrinologists, they're the hormonal detectives of the body and, you know, it's fascinating.
Health Matters: In your practice do you see a lot of this adrenal gland problems, or is it rare?
Dr. Tamber: It's fairly rare. It makes up a fairly small percentage of my practice.
Health Matters: Is there a genetic component? I mean, we talked about John F. Kennedy having Addison's. Is that genetically passed down?
Dr. Tamber: There's probably a genetic component to the autoimmune feature. In other words, there may be that genetic predisposition to develop it, although not everyone with that genetic makeup is necessarily going to develop the disease.
Health Matters: And treatment? Is there like a new treatment or research on the horizon for this?
Dr. Tamber: There is some research. The research about cortisol replacement in Addison's disease mainly focuses on the type of steroid that we are giving as a replacement therapy, because right now we actually don't have the perfect treatment for Addison's disease or adrenal insufficiency from any cause. The problem is that in a normal person whose adrenal glands are working perfectly, the cortisol levels actually reach their peak very early in the morning. Generally, before the person even wakes up. And, that's essentially to get the body ready to start working for the day. The cortisol levels start to rise, they tell the liver to start releasing sugar into the bloodstream so the rest of the body can start using that sugar to do what it needs to do, and the cortisol levels will be up at those early morning hours. But, unfortunately, people are sleeping when that happens. So, the ideal therapy for adrenal insufficiency would be a pill that gives you that cortisol peak before you even wake up, but we don't have that pill. We don't have that kind of delayed release pill that would give us a spike just at that right time. What we've got is we've got hydrocortisone, and hydrocortisone is probably the most commonly used steroid. There are other steroids that are used for adrenal insufficiency as well, like prednisone and dexamethasone, but my preference is usually hydrocortisone, which is a little bit shorter acting of a steroid, so if people take the largest dose when they wake up in the morning to try to mimic that early morning peak of cortisol.
Health Matters: Dr. Michael Tamber, endocrinologist from The Everett Clinic, thanks so much for being on with us.