Adrenal Insufficiency
What is it?
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.
Who gets it?
Adrenal insufficiency occurs in about four in every
100,000 people. The condition can strike both men and
women of all ages, but is more common in middle-aged
women.
What causes it?
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.
What are the symptoms?
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.
How is it diagnosed?
Many people do not recognize the slow progression of
symptoms of adrenal insufficiency and it is ultimately
identified when a doctor notices the areas of increased
pigmentation of the skin. A doctor will run laboratory
blood tests to reveal abnormally low blood concentrations
of sodium and glucose, a greater than normal level of
serum potassium, and a decreased urinary output of certain
steroids. The doctor will diagnosis adrenal insufficiency
if the amount of cortisol in the plasma and steroid in the
urine does not increase after the patient takes a
synthetic steroid.
What is the treatment?
Treatment of adrenal insufficiency includes replacing
missing or low levels of cortisol with synthetic steroids
such as glucocorticoid, adrenal genital corticoids, and
mineralocorticoid drugs. 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.
Self-care tips
Early diagnosis and treatment for patients diagnosed
with adrenal insufficiency will usually be life-saving.
However, patients need to be aware of the significance of
emotional distress, the value of wearing a medical-alert
bracelet or tag, the signs of impending crisis, the use of
a prepared kit for emergencies, and the importance of
careful attention to drug use and diet. In addition,
steroid replacements should only be taken after meals or
with milk to prevent gastric irritation and the
development of ulcers. Most patients following treatment
can expect to enjoy a fully active life and normal
lifespan.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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