Adrenal Insufficiency

In the case of adrenal insufficiency, the adrenal cortex can no longer produce enough hormones. Here, a distinction must be made between primary and secondary adrenocortical insufficiency depending on the location.

Adrenal Insufficiency

What is Adrenal Cortical Insufficiency?

About 5 out of 100,000 people suffer from this rare disease. Primary adrenal insufficiency is also known as Addison’s disease. If the adrenal cortex can no longer work properly, this can lead to a life-threatening situation.┬áSee phonejust for Hemorrhoids Meaning.

The adrenal gland consists of the adrenal cortex, which produces cortisol, aldosterone, and sex hormones, and the adrenal medulla, which produces adrenaline and noradrenaline. The hormone ACTH, which is produced in the anterior pituitary gland of the pituitary gland, controls the production of cortisol. When blood levels of cortisol fall, more ACTH is secreted, boosting production in the adrenal glands.

But aldosterone, which is responsible for regulating the concentration of potassium and sodium, is also formed in the adrenal cortex. In contrast to cortisol, however, the production of this hormone is not regulated by the pituitary gland, but by the RAAS.

Causes

The causes of adrenal insufficiency can be different. First of all, it must be diagnosed whether it is a primary or secondary adrenal insufficiency. This provides information about the localization of the cause of the disease.

In the primary form, the ANR can no longer produce any of the required hormones. So she’s sick herself. In the secondary form, the hypothalamus is diseased, which also means that no hormones can be produced.

This is simply due to the fact that the hypothalamus stops sending CRH to the pituitary gland, which in turn stops sending ACTH to the adrenal cortex. ACTH stimulates the production of cortisol. The production of aldosterone is only slightly affected.

Symptoms, Ailments & Signs

Symptoms of adrenal insufficiency usually only appear when 90 percent of the adrenal cortex has already been destroyed. A distinction is made between general symptoms and specific symptoms. The latter are due to a lack of the hormones cortisol and/or aldosterone. The general symptoms include nausea and vomiting, loss of appetite, weight loss, fatigue, significantly reduced performance and non-specific gastrointestinal symptoms.

A lack of cortisol also leads to dehydration, which brings with it the risk of acute renal failure. In addition, there is acidification of the blood, low blood pressure (usually systolic < 100 mm Hg), dizzy spells and reduced sodium levels and increased potassium levels in the blood, the latter being associated with an increased risk of cardiac arrhythmia.

A lack of cortisol can also lead to low blood sugar, which usually manifests itself in the form of anxiety, sweating and palpitations. In addition, it can lead to mental disorders, brown skin pigmentation (hyperpigmentation) and the breakdown of fat and muscle mass.

Additional stress, such as surgery or illness, can suddenly worsen adrenal insufficiency. In particular, if left untreated, this leads to a potentially fatal condition characterized by impaired consciousness through to coma, drop in blood pressure, fever, dehydration, and hypoglycemia.

Diagnosis & History

Some tests are necessary to diagnose adrenal insufficiency. In addition to a blood count, urine must be collected for 24 hours and a daily cortisol profile must also be set up.

In addition, it is within the realm of possibility that an ACTH test will be ordered. Since cortisol manages stress, people are particularly at risk in stressful situations. The disease can even lead to an Addisonian crisis, which can be deadly. For this reason, a patient must always carry an emergency card and cortisone with them.

The Addisonian crisis is an extreme drop in cortisol levels. This will initially manifest itself in states of weakness, restlessness and fears. But also extreme cold, diarrhea and vomiting will appear without treatment. In this sense, however, the term stress includes physical exertion, such as operations, accidents and infectious diseases.

Complications

In the worst case, the adrenal insufficiency can lead to the death of the person concerned. For this reason, this disease must be treated in any case, since self-healing usually does not occur. In the case of adrenal insufficiency, those affected primarily suffer from general weakness. Furthermore, they lose weight for no particular reason and also suffer from a high susceptibility to infections.

This means that various infections or inflammations occur more often and easily. As a rule, this disease also leads to severe abdominal pain, vomiting and nausea. The patients suffer from severe hunger, with salty foods being preferred. Dizziness or pallor can also occur with adrenal insufficiency and significantly reduce the patient’s quality of life.

It can also lead to hypoglycaemia and loss of consciousness in the patient. Adrenal insufficiency is treated with medication. There are no particular complications. However, the thyroid gland of the person concerned must also be examined, as this can also be affected by a malfunction. With successful and correct treatment, the life expectancy of the person affected is not reduced.

When should you go to the doctor?

Adrenal insufficiency usually only becomes noticeable when large parts of the kidney have already been destroyed. The cause should therefore be treated as early as possible. People who suffer from alcoholism or diabetes are among the risk patients and must be treated closely so that adrenal insufficiency does not develop in the first place. At the latest when signs such as persistent tiredness, nausea and vomiting as well as loss of appetite are noticed, a doctor must be consulted about the condition. Non-specific complaints in the gastrointestinal area also require rapid clarification.

If you experience dizziness, an abnormal heart rhythm, or weakness, you may have severe dehydration that needs medical attention. Anxiety and other psychological ailments also indicate a lack of nutrients. It is best for affected people to talk to their family doctor, who can diagnose the condition or consult a specialist. Adrenal insufficiency is treated by a nephrologist or other internist. Any psychological complaints that may arise in connection with the disease must be treated therapeutically.

Treatment & Therapy

Once the problem of adrenal insufficiency is identified and therapy is given, there will most likely be no major incidents if taken properly.

Cortisol should usually be taken twice a day. However, since some patients experience problems at night, it can also be taken several times a day. It is particularly worth knowing that the drugs have a long-term effect, which means that high doses are strictly prohibited.

In addition, preparations are offered that break down quickly. This includes, for example, hydrocortisone, which is increasingly used in the Addisonian crisis or in emergencies. This can be administered in high doses. Furthermore, adrenal insufficiency patients should not exert themselves too much in everyday life. You should give your body enough sleep every day.

If there is an infection, a doctor should be consulted immediately, as the cortisol dose must be increased. After the illness, however, the drug can be slowly reduced again. If it is secondary hypothyroidism, thyroid hormones often have to be taken as well. Although adrenal insufficiency cannot be cured, it can be easily treated, which means that the quality of life can be maintained.

Outlook & Forecast

Adrenal insufficiency (also known as Addison’s disease) is an incurable disease because once damage to the adrenal cortex occurs, it cannot be reversed. However, if chronic, slow-moving adrenal insufficiency is detected early enough, treatment with vital hormones is possible.

This hormone replacement has to be taken for a lifetime, but the patients can then live an almost normal life and also have an average life expectancy if the prescribed medication is taken regularly. In the case of adrenal insufficiency, pregnancy is very often possible if those affected have their hormone levels checked regularly or if they are properly adjusted.

Problems can arise when the concentration of hormones does not correspond to the prevailing stress level of the patient. If adrenal insufficiency is not treated, the disease is always fatal. There is also a danger to life in an acute Addisonian crisis, especially if this occurs together with the so-called Waterhouse-Friderichsen syndrome. The prospects of an almost symptom-free life are therefore increased enormously by timely action. Therefore, the first symptoms and warning signs should be taken seriously by those affected.

Prevention

Unfortunately, there are no concrete and proven measures to prevent adrenal insufficiency, but you should nevertheless follow a few rules. Anyone who falls ill should carry an ID card and emergency medication with them. This way you always have the situation under control.

Stress should be avoided for the most part. The dose of cortisol must be increased before operations and during infections in order to avoid an Addisonian crisis. A healthy lifestyle will avoid diseases that are known to be possible causes of primary and secondary Addison’s disease.

Aftercare

In most cases, those affected with adrenal insufficiency have only very few and often only very limited direct follow-up measures available. First and foremost, those affected should consult a doctor very early on in order to prevent and limit the occurrence of other complications and symptoms. Adrenal insufficiency usually cannot heal on its own, so a doctor should be consulted at the first sign of the disease.

As a rule, those affected by adrenal insufficiency are dependent on taking various medications. Those affected should follow the doctor’s instructions and ensure that they are taken regularly and at the right dosage.

Regular check-ups by a doctor are often very important for the disease. Furthermore, the person concerned should rest and rest a lot, whereby heavy exertion or physical activities should be avoided. Likewise, the help and care of one’s own family has a positive effect on the further course of the disease and can sometimes prevent the development of mental disorders.

You can do that yourself

Adrenal insufficiency is a hormonal disorder. In addition to therapy with cortisone, those affected can take some measures to increase their well-being. Victims often feel exhausted. It is therefore advisable to structure the day well. Too many appointments in one day or too many activities in sports or in the household can lead to overwhelm.

Since Addison patients often suffer from low blood sugar, several small meals at intervals of about 3-4 hours are recommended. This keeps blood sugar stable for longer. A banana or a slice of bread in between can be enough. Whole grain products are well suited for blood sugar stability. In order to be able to prevent hypoglycaemia on the go, it is a sensible measure to have glucose, a sweet drink such as apple juice or a banana with you in your handbag or backpack. This means that dangerous hypoglycaemia cannot occur during longer walks or appointments. Cortisone tablets and an emergency card also belong in the bag.

Listening to your body’s signals is also important. If you feel exhausted, it’s advisable to take a break, even if others don’t understand it. Addison patients do better when you listen to your body’s signals and learn to say no.