Adrenal Insufficiency

June 09 23:10 2019 Print This Article

Adrenal insufficiency refers to the inability of the adrenal glands to produce a normal quantity of hormones . Adrenal insufficiency is characterized by a deficiency of one or more of these classes of hormones. Glucocorticoids help regulate blood sugar levels and the metabolism of protein and fat. They have important actions on the body’s immune response and are particularly important in helping the body buffer any kind of stress. Mineralocorticoids help regulate the body’s sodium and potassium levels, blood volume, and blood pressure.

In women, adrenal androgens affect secondary characteristics such as underarm and pubic hair in women and may be important for their libido .They are not important for men, who produce most of their androgen in the testes. In primary adrenal insufficiency the problem lies at the level of the adrenal gland. Other causes include high doses of medications used to lower cortisol levels in Cushing’s syndrome or as a consequence of surgery for pituitary tumors.

Patients who have been on long-term glucocorticoid therapy in the past may develop adrenal insufficiency later if they are subjected to acute stress, trauma, or infection. Secondary autoimmune conditions in APS Syndrome occur in about 50 percent of patients with primary or autoimmune adrenal insufficiency. In only about five percent of patients with other autoimmune conditions, particularly diabetes, does Addison’s disease later occur.

Adrenal insufficiency is a life-threatening condition caused by the disrupted functioning of the adrenal gland called the cortex. The condition causes decreased production of two important hormones normally released by the cortex, cortisol and aldosterone. Infection or hemorrhaging of the gland often results, and all functions of the gland are lost. Adrenal insufficiency is a rare endocrine, or hormonal disorder that affects about 1 in 100,000 people. It occurs in all age groups and afflicts men and women equally.

Patients diagnosed with adrenal insufficiency typically experience fatigue and loss of energy, loss of appetite, nausea, vomiting, diarrhea, abdominal pain, weight loss, muscle weakness, dizziness when standing, dehydration, anxiety and depression. The patient may also notice increased bronze pigmentation of the skin and mucous membranes and decreased tolerance to cold. Women lose pubic and underarm hair and stop having normal menstrual periods. Unfortunately, significant symptoms are usually not noticed until about 90% of the adrenal cortex has been destroyed.

In secondary adrenal insufficiency, the problem lies at the level of the pituitary gland, and in tertiary adrenal insufficiency, at the hypothalamus. Pituitary or hypothalamic tumors or masses can cause this problem. In addition, some people are born with deficiencies in one or more of the pituitary hormones. Additionally, long term treatment with glucorticoid medications can inhibit normal pituitary function and cause secondary adrenal insufficiency. Early detection of adrenal insufficiency can be difficult, but in most cases, this condition is readily treatable once diagnosed. The specific type of treatment is tailored to the underlying cause, and in most cases, lifelong treatment is necessary.

Causes of Adrenal Insufficiency

The shrinking or destruction of the adrenal cortex from an autoimmune disorder is the most common cause of adrenal insufficiency. In a person with an autoimmune disorder, the body accidentally identifies the cells of the adrenal cortex as foreign, destroying them. Other causes of the shrinking or destruction of the adrenal cortex are tuberculosis, fungal infection, a disease called amyloidosis, or cancer.

  • Poor diet.
  • Heavy smoking and alcohol intake.
  • Chronic viral infections.
  • Long-term use of cortisone-type drugs can be a secondary cause of adrenal failure.

Signs and Symptoms of Adrenal Insufficiency

Patients diagnosed with adrenal insufficiency typically experience fatigue and loss of energy, loss of appetite, nausea, vomiting, diarrhea, abdominal pain, weight loss, muscle weakness, dizziness when standing, dehydration, anxiety and depression. The patient may also notice increased bronze pigmentation of the skin and mucous membranes and decreased tolerance to cold. Women lose pubic and underarm hair and stop having normal menstrual periods. Unfortunately, significant symptoms are usually not noticed until about 90% of the adrenal cortex has been destroyed.

  • Muscle and joint pain.
  • Fatigue.
  • Low blood pressure.
  • Muscle weakness.
  • Poor circulation.
  • Anorexia.
  • Weight loss.
  • Abdominal pain.

Treatment for Adrenal Insufficiency

Treatment consists of giving additional glucocorticoids. Higher doses are needed in stressful situations (such as during infections, or prior to and after surgery). Patients with adrenal insufficiency will need to take a steroid by mouth for the rest of their lives. Resulting dehydration and salt loss should be treated with an adequate fluid intake and a diet high in complex carbohydrate and protein. Dangerously low blood pressure may require special medications to safely elevate it until the steroids take effect. Follow-up care includes frequent monitoring of blood sugar and urinary acetone levels and continued administration of the steroids.