Adrenal Disorders:
Sequoia Medical 360
Precision Care for Stress Biology, Metabolism & Blood Pressure in Bronxville & Westchester, NY
Two small, triangular glands sit atop your kidneys and help determine how you respond to stress, regulate blood pressure and electrolytes, balance blood sugar, maintain immune resilience, and sustain daily energy. These are your adrenal glands—and when their hormones drift too high or too low, the ripple effects can touch every system: heart, brain, muscle, metabolism, mood, and sleep.
At Sequoia Medical 360 in Bronxville, serving all of Westchester and New York State via telehealth, we provide advanced, concierge-level evaluation and treatment for the full spectrum of adrenal disorders. Guided by Dr. Tony Mathews’ dual fellowship training in Endocrinology, Diabetes & Metabolism and Preventive Cardiology, our approach blends exacting diagnostics with individualized therapy to restore hormonal equilibrium and protect long-term health.
What the Adrenals Do (and Why It Matters)
Each adrenal gland has two functional layers:
Adrenal cortex:
Adrenal medulla:
Symptoms of adrenal imbalance are diverse—fatigue or “wired-and-tired,” weight gain or loss, resistant hypertension or low blood pressure, salt craving and cramps, palpitations, headaches, anxiety, easy bruising, muscle weakness, or electrolyte shifts. The pattern points to the cause; precise testing confirms it.
Conditions We Evaluate & Treat
Primary Adrenal Insufficiency (Addison’s Disease)
Secondary (Pituitary) Adrenal Insufficiency
Autoimmune destruction (most common in developed nations) or infections/infiltrative disease damages the adrenal cortex, reducing cortisol ± aldosterone.
Clues: Chronic fatigue, weight loss, low blood pressure, salt craving, abdominal discomfort, skin darkening (hyperpigmentation), low sodium/high potassium.
Sequoia approach: Morning cortisol and ACTH, electrolytes, renin/aldosterone; ACTH stimulation testing when indicated. Treatment uses physiologic glucocorticoid replacement (with sick-day rules and travel letters) and mineralocorticoid if needed. We prioritize crisis prevention education and medical alert planning.
Pituitary or hypothalamic dysfunction—or chronic glucocorticoid therapy—suppresses ACTH, lowering cortisol production (aldosterone typically preserved).
Clues: Fatigue, orthostasis, hyponatremia—often without hyperpigmentation or high potassium.
Care: ACTH axis evaluation, cautious glucocorticoid replacement, and coordination with pituitary imaging and other pituitary hormone testing if needed.
A life-threatening cortisol deficit precipitated by illness, dehydration, surgery, or missed doses in a patient with known or unrecognized adrenal insufficiency.
Clues: Severe weakness, vomiting, abdominal pain, hypotension/shock, confusion.
Care: Immediate IV hydrocortisone and fluids/electrolytes. At Sequoia, we work to prevent crisis with proactive education, injection kits, and explicit stress-dosing plans.
Adrenal Crisis (Emergent)
Cushing’s Syndrome (Hypercortisolism)
Prolonged exposure to excess cortisol—due to adrenal adenoma/carcinoma, iatrogenic steroids, or (less commonly) pituitary ACTH overproduction (Cushing’s disease).
Clues: Rapid central weight gain, facial rounding, supraclavicular fullness, easy bruising, thin skin/purple striae, proximal muscle weakness, hypertension, diabetes, mood changes, and bone loss.
Diagnostics: Stepwise confirmation (late-night salivary cortisol, low-dose dexamethasone suppression, 24-hour urine free cortisol), then source localization with adrenal or pituitary imaging.
Therapy: Surgical removal when feasible (adrenal or pituitary), cortisol-lowering medications when surgery is not possible or as a bridge, plus targeted protection for bone and cardiometabolic health. Long-term recurrence surveillance is standard.
Primary Hyperaldosteronism (Conn’s Syndrome)
Excess aldosterone from a unilateral adenoma or bilateral hyperplasia.
Clues: Resistant hypertension, muscle cramps, low potassium, metabolic alkalosis—or sometimes only hard-to-control blood pressure.
Diagnostics: Aldosterone-to-renin ratio screening; confirmatory suppression testing; adrenal imaging; and adrenal vein sampling (AVS) when considering surgery to differentiate unilateral from bilateral disease.
Therapy: Adrenalectomy for unilateral aldosteronoma (often curative); mineralocorticoid receptor antagonists (e.g., spironolactone, eplerenone) for bilateral disease. We pair therapy with precise BP, electrolyte, and kidney function monitoring.
Pheochromocytoma & Paraganglioma
Catecholamine-secreting tumors (typically adrenal for pheochromocytoma; extra-adrenal for paraganglioma).
Clues: Paroxysmal headaches, palpitations, sweating, pallor, BP spikes, panic-like episodes; glucose variability; weight loss.
Diagnostics: Plasma or 24-hour urinary metanephrines, dedicated imaging (CT/MRI) and functional imaging when indicated; genetic testing in select cases.
Therapy: Alpha-blockade before any surgery (critical), then surgical resection in experienced
hands. We coordinate peri-operative plans with anesthesia, cardiology, and high-volume endocrine surgeons.
Adrenal Incidentaloma (Incidentally Found Adrenal Mass)
Frequently discovered on scans done for other reasons. The two key questions: Is it secreting? Is it malignant?
Evaluation framework:
Adrenocortical Carcinoma (ACC)
A rare but aggressive cortical malignancy that may produce cortisol, androgens, or aldosterone.
Clues: Rapid mass growth, virilization, profound Cushingoid features, or refractory hypertension.
Care: Multidisciplinary evaluation; surgical resection when feasible; adjuvant therapies as indicated; meticulous endocrine management during and after treatment.
Congenital Adrenal Hyperplasia (CAH)
Inherited enzyme deficiencies (most commonly 21-hydroxylase deficiency) disrupting cortisol ± aldosterone synthesis and elevating androgens.
Clues: Salt-wasting in infancy, early virilization, menstrual irregularities, fertility challenges, adrenal crises under stress.
Care: Nuanced glucocorticoid ± mineralocorticoid replacement, stress-dosing education, growth and fertility-aware plans, and ongoing metabolic/bone monitoring.
Structural, Vascular & Infectious Causes
Adrenal hypoplasia, hemorrhage, and infections (e.g., adrenal tuberculosis) can impair function acutely or chronically.
Care: Stabilization, targeted therapy (e.g., antimicrobials), and hormone replacement with serial reassessment.
About “Adrenal Fatigue”
You may encounter the term “adrenal fatigue” online. While chronic stress is real and can disrupt sleep, mood, and performance, “adrenal fatigue” is not a recognized medical diagnosis. At Sequoia, we take your symptoms seriously and perform a thorough, evidence-based evaluation to identify treatable causes—thyroid disorders, iron deficiency, sleep apnea, insulin resistance, depression/anxiety, medication effects—and build a plan that truly helps you feel and function better.
Our Diagnostic Playbook: Clarity Over Guesswork
1) Biochemical Testing (Right test, right context)
2) Imaging (High-resolution, problem-oriented)
3) Cardiometabolic Context
4) Medication & Supplement Audit
We systematically review prescriptions and supplements that skew results (steroids, oral estrogens, decongestants, licorice, biotin, certain antidepressants or BP meds) and optimize testing windows accordingly.
Personalized Treatment & Long-Term Monitoring
Calcium is vital for fetal skeletal development and maternal bone strength. Disorders of calcium regulation require precise management to avoid risks for both mother and child.
- Replacement: Physiologic glucocorticoids ± mineralocorticoids for adrenal insufficiency, with sick-day rules and crisis kits.
- Block/replace strategies: Mineralocorticoid receptor antagonists for hyperaldosteronism; alpha- then beta-blockade for pheochromocytoma; cortisol-lowering agents for Cushing’s when needed.
- Surgical partnerships: Seamless referrals to high-volume endocrine surgeons; meticulous peri-operative endocrine planning.
Why Sequoia Medical 360 for Adrenal Care
Take the Next Step
If you’re experiencing unexplained fatigue, difficult blood pressure, palpitations, headaches, salt/potassium imbalance—or you’ve been told you have an adrenal mass—clarity starts here.