Adrenal Disease Specialist in Guatemala City
High cortisol, high blood pressure, fatigue. The adrenal glands may be the answer.
Cortisol is not just the 'stress hormone.' The adrenal glands control blood pressure, metabolism, immunity, and the stress response. Their dysfunction has systemic consequences that are frequently attributed to other causes.
When should you see an endocrinologist?
An adrenal nodule was found incidentally on a CT scan or MRI
You have abdominal and facial weight gain, purple stretch marks, or muscle weakness
You have hypertension that is difficult to control with medications
You have extreme fatigue, dizziness when standing, or hyperpigmentation
You were diagnosed with hyperaldosteronism or have unexplained low potassium
You suspect or have been told you may have Cushing's syndrome
⚡ Consultations Monday through Saturday | By appointment only
1–2%
of abdominal CT scans detect an adrenal incidentaloma
10%
of adrenal incidentalomas require treatment or surgery
Cushing's
takes an average of 4–8 years to be correctly diagnosed
Addison's
can be fatal if untreated — but is perfectly managed with treatment
The adrenal glands: small glands, enormous systemic impact.
The adrenal glands produce cortisol, aldosterone, adrenaline, and adrenal androgens. They regulate blood pressure, glucose metabolism, immune response, sodium and potassium balance, and the response to physical and emotional stress.
When they produce too much (Cushing's, hyperaldosteronism, pheochromocytoma) or too little (Addison's, adrenal insufficiency), the consequences are systemic and can be serious if not diagnosed in time. Incidentalomas — adrenal nodules found incidentally — require a specific protocol to determine whether they are functioning or malignant.
“Cushing's syndrome is one of the most underdiagnosed diseases in endocrinology. Its symptoms resemble obesity, diabetes, and depression — which is exactly why it gets overlooked.”—Dra. Ma. Eugenia Penados
Adrenal symptoms that mimic other diseases.
Adrenal diseases are experts at disguise. Their symptoms are frequently attributed to obesity, depression, essential hypertension, or simply stress — delaying diagnosis by years.
Central obesity and moon face
Fat accumulation in the abdomen, neck, and face (moon face) with thinning of the limbs — a characteristic pattern of hypercortisolism.
Purple stretch marks
Purple-violet stretch marks on the abdomen, flanks, thighs, and armpits — different from ordinary white stretch marks. A sign of cortisol excess.
Muscle weakness
Difficulty rising from a chair, climbing stairs, or lifting the arms — proximal myopathy due to hypercortisolism.
Resistant hypertension
High blood pressure that does not respond well to multiple medications — may indicate primary hyperaldosteronism or Cushing's.
Extreme fatigue and dizziness
Especially when standing up (orthostatic hypotension) — a classic sign of adrenal insufficiency (Addison's).
Hyperpigmentation
Darkening of the skin in folds, scars, and mucous membranes — a sign of primary adrenal insufficiency due to excess ACTH.
Low potassium (hypokalemia)
Low blood potassium — may indicate primary hyperaldosteronism or Cushing's syndrome with ectopic production.
Episodic headache and palpitations
With profuse sweating — the classic triad of pheochromocytoma, an adrenal tumor that produces catecholamines.
Do you identify with any of these symptoms?
A one-hour initial consultation is all it takes to begin your evaluation and, when needed, reach a clear diagnosis
The main adrenal diseases
Each adrenal disease has a completely different pathophysiology, presentation, and management. Rigorous differential diagnosis is what defines treatment.
Cushing's Syndrome
Chronic exposure to excess cortisol — caused by a pituitary tumor (Cushing's disease), adrenal tumor, or ectopic production. Requires multiple tests to confirm and locate the cause.
Addison's Disease
Autoimmune destruction of the adrenal glands with cortisol and aldosterone deficiency. Can be potentially fatal in crisis — but is perfectly managed with hormonal treatment.
Adrenal Incidentaloma
Adrenal nodule found incidentally on imaging. Requires functional evaluation (does it produce excess hormones?) and malignancy assessment. Most are benign and non-functioning.
Primary Hyperaldosteronism
Autonomous aldosterone production — the most common cause of secondary hypertension. Suspected in resistant hypertension or unexplained low potassium. Treatable with medication or surgery depending on the cause.
Adrenal diseases require specific functional tests — measuring baseline cortisol alone is not enough. The dexamethasone suppression test, 24-hour urinary free cortisol, and late-night salivary cortisol are the screening tests for Cushing's. The diagnosis requires confirmation with multiple tests before proceeding to imaging or treatment.
How adrenal diseases are diagnosed during your consultation
Adrenal diagnosis requires a stepwise approach: first confirm the hormonal excess or deficiency, then locate the cause. Imaging cannot be ordered before functional dysfunction is confirmed.
Adrenal medical history
Symptoms, duration, changes in weight and physical appearance, medications (especially corticosteroids), history of surgeries or tumors.
Targeted physical examination
Assessment of fat distribution, stretch marks, muscle weakness, blood pressure in different positions, mucous membrane and skin fold pigmentation.
Hormonal functional tests
Baseline and late-night cortisol, 1 mg dexamethasone suppression test, 24-hour urinary free cortisol, ACTH, aldosterone and renin, urinary or plasma metanephrines depending on clinical suspicion.
Adrenal imaging (if indicated)
Adrenal CT with thin cuts for nodule characterization. Imaging comes AFTER functional dysfunction is confirmed — not before.
Rigorous differential diagnosis
Distinction between pituitary, adrenal, and ectopic Cushing's. Evaluation of adenoma vs. bilateral hyperplasia in hyperaldosteronism. Incidentaloma characterization.
Coordination with other specialties
Neurosurgery for pituitary Cushing's, adrenal surgery for tumors, interventional radiology for adrenal vein sampling when applicable.
Why see Dr. Penados for adrenal diseases?
Specialized differential diagnosis
Adrenal diseases are complex and uncommon. Dr. Penados works with up-to-date diagnostic protocols to avoid both false positives and underdiagnosis — two errors that are all too common and are avoided here.
Management of complex and rare cases
Adrenal diseases are exactly the type of complex case where subspecialty training at a referral center like Hospital José E. González at UANL makes a real difference.
Complete protocol in a single consultation
The first hour includes history, physical exam, diagnostic protocol design, and a clear explanation of the plan — without sending the patient away without direction to get tests that may not even be the right ones.
Management based on up-to-date international guidelines
The Endocrine Society guidelines for Cushing's, Addison's, and adrenal incidentalomas are constantly updated. Dr. Penados works with the most current recommendations — not criteria from a decade ago.
Specialized differential diagnosis
Adrenal diseases are complex and uncommon. Dr. Penados works with up-to-date diagnostic protocols to avoid both false positives and underdiagnosis — two errors that are all too common and are avoided here.
Management of complex and rare cases
Adrenal diseases are exactly the type of complex case where subspecialty training at a referral center like Hospital José E. González at UANL makes a real difference.
Complete protocol in a single consultation
The first hour includes history, physical exam, diagnostic protocol design, and a clear explanation of the plan — without sending the patient away without direction to get tests that may not even be the right ones.
Management based on up-to-date international guidelines
The Endocrine Society guidelines for Cushing's, Addison's, and adrenal incidentalomas are constantly updated. Dr. Penados works with the most current recommendations — not criteria from a decade ago.
Ready to receive specialized endocrinological care?
Experience the difference of comprehensive, personalized, evidence-based treatment
Specialized Endocrinology in Guatemala
Clínica de Endocrinología, Metabolismo y Medicina Interna, Dra. Ma. Eugenia Penados Ovalle
6a avenida 4-01 zona 10, Edificio Medika 10, Nivel 3 (N3) Clínica 307Modern practice in the heart of Guatemala City
Office Hours
Monday, Tuesday, Thursday from 9:00 AM to 4:00 PM Friday from 9:00 AM to 1:00 PM Saturday from 8:00 AM to 12:00 PM
Emergency Care
Dr. Penados does not treat emergencies. For medical urgencies, please go to the emergency department of a hospital.
Coverage Areas
Guatemala City
- • Zone 10, 14, 15
- • Zone 9, 13, 16
- • Highway to El Salvador
Metropolitan Area
- • Mixco
- • Villa Nueva
- • Santa Catarina Pinula
- • San Cristóbal
Nationwide Coverage
- • All departments of Guatemala
- • Patients traveling from across the country
- • Periodic visits to Petén (approx. every 6 weeks)
Common questions, clear answers
Still have questions? Let's talk directly on WhatsApp for personalized answers.