What is adrenal insufficiency?
Adrenal insufficiency is a condition in which the adrenal glands, organs which are located on top of the kidneys, no or do not produce sufficient amounts of the steroid hormones, particularly the stress hormone cortisol, aldosterone but also the production (a mineralocorticoid) which controls the sodium, potassium and water retention may be disrupted. Desire for salt or salty foods as a result of the loss of sodium in the urine by a deficiency of aldosterone is usual.
A related term, adrenal fatigue, is not recognized by medical professionals. The term is used for a number of non-specific symptoms, such as pain in the body, tiredness, nervousness, sleep disorders, and digestive problems. The term also appears frequently in popular health books and websites about alternative medicine, but has no accepted medical diagnosis.
Addison's disease, the adrenogenital syndrome, and Cushing's disease can manifest as adrenal insufficiency. If this condition is not treated, it can cause severe abdominal pain, diarrhea, vomiting, severe muscle weakness and fatigue, depression, extremely low blood pressure (hypotension), weight loss, kidney failure, changes in mood and personality, "brain fog" and shock (adrenal crisis). An acute adrenal insufficiency (Addison's crisis) often occurs when the body is exposed to a form of stress, such as in an accident, injury, surgery, severe infection and / or fever or acute stress situations such as the death of a neighbor. Death may quickly follow.
Adrenocortical insufficiency can also occur where the hypothalamus and the pituitary gland, both located in the base of the skull, do not produce sufficient amounts of hormones which are necessary in the regulation of adrenal function, this is the so-called secondary adrenocortical insufficiency, and is caused by a lack of the production of ACTH in the pituitary gland, or the absence of CRH in the hypothalamus.
Types
There are three types of adrenal insufficiency.
- Primary adrenal insufficiency as a result of impairment of the adrenal glands. This is known as Addison's disease.
- 80% is due to an autoimmune disease or autoimmune adrenalitis.
- Other cases are the result of adrenogenital syndrome or an adenoma (benign tumor) of the adrenal gland.
- The disease is called idiopathic if there is no known cause of the adrenal insufficiency.
- Secondary adrenal insufficiency is caused by damage to the pituitary or hypothalamus. This may be due to an adenoma: a hypofysemicroadenoom hypothalamus or a tumor; Sheehan's syndrome, which is associated with a reduction of only the pituitary gland; or a past head injury.
- Tertiary adrenal insufficiency is due to hypothalamic disease and reduction of corticotropin releasing factor (CRF).
Causes of adrenal insufficiency
Causes of acute adrenal insufficiency are mainly syndrome Waterhouse-Friderichsen, the sudden withdrawal of prolonged treatment with corticosteroids and stress in patients with underlying chronic adrenal insufficiency. The latter is referred to as critical illness-related corticosteroid insufficiency.
For chronic adrenal insufficiency are the main causes autoimmune adrenalitis, tuberculosis, AIDS and metastatic disease. Small causes of chronic adrenal insufficiency have systemic amyloidosis, fungal infections, hemochromatosis and sarcoidosis.
Auto-adrenalitis may be a part type 2 autoimmune polyglandular syndrome, which can cause also type 1 diabetes, hyperthyroidism, autoimmune thyroid disease (also known as auto-immune thyroiditis and Hashimoto's disease). Hypogonadism and pernicious anemia may also be present with this syndrome.
Adrenoleukodystrophy can also lead to adrenal insufficiency.
Adrenal insufficiency can also be caused when a patient has a Craniopharyngioma. This is a benign tumor that can damage the pituitary gland, causing the adrenal glands do not function. This is an example of secondary adrenal insufficiency.
Adrenal insufficiency symptoms
The person may have symptoms of hypoglycemia, dehydration, weight loss and disorientation. He or she is experiencing weakness, fatigue, dizziness, low blood pressure that falls further when standing (orthostatic hypotension), muscle aches, nausea, vomiting and diarrhea. These problems may develop gradually and insidiously. Addison's disease can be accompanied by brownish discoloration of the skin, fragmentary, or even over the entire body. Typical areas of brownish discoloration of the skin folds (eg of the hands) and the inside of the cheek. Goitre and vitiligo may also be present.
Adrenal insufficiency diagnosis
If the person is in an adrenal crisis, the ACTH stimulation test can be performed. If that is not the case may be from a blood sample, the cortisol, ACTH, aldosterone, renin, sodium and potassium are determined, before the decision is taken whether the ACTH-stimulation test to be performed. There may also be an x-ray or CT will be made of the adrenal glands. The best test for adrenal insufficiency of auto-immune origin, responsible for more than eighty percent of all cases, in the western population, is the measurement of 21-hydroxylase autoantibodies.
Adrenal insufficiency treatment
- Acute adrenal insufficiency
- Intravenous liquid
- Intravenous corticosteroids (Solu-Cortef / injectable hydrocortisone) later hydrocortisone, prednisone tablets or methylpredisolon
- peace
- Cortisol dependence (primary and secondary)
- Hydrocortisone 15 mg to 40 mg (mean daily dose of 20 to 30 mg)
NOTE: The hydrocortisone dosage should be spread throughout the day, most of it on awakening and the rest in one or two doses to mimic the normal daily cycle.
- Prednisone (Deltason) (7.5 mg)
- Prednisolone (Delta-Cortef) (7.5 mg)
- Methylprednisolone (Medrol) (6 mg)
- Dexamethasone (Decadron) (12:25 mg, but rarely to 1 mg, higher doses have a tendency to cause the side effects that are similar to Cushing's disease.)
- Mineralcorticoid deficiency (low aldosterone)
- Fludrocortisone acetate 0 to 0.4 mg if needed (mean daily dose of 0.05 to 0.2 mg)