Adrenocortical Insufficiency

Adrenocortical Insufficiency – General Information

Adrenocortical Insufficiency (also known as Hypocorticoidism or Addison’s disease) is medical disorder characterized by the failure of the adrenal gland due to the impossibility of the gland to produce enough hormones. The severe and chronic cases lead to Addison’s disease.
The secondary Adrenocortical Insufficiency due to the deficiency of adrenocorticotropic hormone (also known as ACTH, is a hormone produced by the pituitary gland) leads to deficiencies in the production of cortisol hormone. The secondary Adrenocortical Insufficiency is caused by:

• Radiation of the hypothalamus or of the pituitary gland
• Previous surgery of the pituitary gland
• Tumor of the pituitary gland
• Long-term treatment with corticosteroid drugs
• Sarcoidosis
• Hemochromatosis

Addison’s disease is caused by the impossibility of the adrenal glands to produce to needed quantity of steroid hormones (glucocorticoids and mineralocorticoids). The hormones include: cortisol (which affects the immune system), aldosterone (which stabilize the blood pressure and the kidneys) and androgens (which are sex hormones).
Here is a list of causes of the Addison’s disease:

• The bacteria of tuberculosis, as it may infect the gland
• Hemorrhage in the adrenal gland, this usually develops in patient which are undergoing anticoagulants treatment.
• Metastatic cancer of breast, lung, kidney and colon
• The side effects of some drugs such as ketoconazole, radiation therapy
• Autoimmune destruction – meaning that the immune system of the patient’s body begins to attack the adrenal glands.
• The removal of the adrenal glands through surgery
• Sarcoidosis
• Amylodisis
• Histoplasmosis
• Meningococcemia

Adrenocortical Insufficiency – Symptoms

It is well known the fact that any medical disorder (including Adrenocortical Insufficiency) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been listed here. This is why we strongly recommend you to contact your personal health care provider whenever you develop any unusual, bothersome or unpleasant symptoms. Your personal physician will be able to tell you if you are suffering from Adrenocortical Insufficiency or from any other medical disorder.
Here is a list of the disease’s most common symptoms:

• Weakness
• Muscle weakness
• Fatigue
• Lightheadedness
• Faintness
• Weight loss
• Muscle aches
• Joint aches
• Loss of appetite
• Nausea/Vomiting
• Anxiety/irritability
• Emotional lability
• Salt craving
• Depression
• Hallucinations
• Tremors
• Seizures
• Dilated pupils
• Tachycardia
• Headaches
• Sweating
• Changes in the mood and personality
• Some patients may develop craving for salty foods, as a consequence of the loss of sodium in the urine.

The medical symptoms can be underlined after some tests are made, which can be done in any hospital. These symptoms may include:

• Goiter (is a swelling in the neck zone, below the larinx) and Vitiligo (also known as leukoderma, is a chronic skin condition, characterized by the loss of the pigmentation), which usually appear at the same time with Addison’s.
• Low blood pressure
• Orthostatic Hypotension

In the case of sever Adrenocortical Insufficiency, symptoms may include:

• Convulsions
• Low blood pressure
• Hypoglycemia
• Loss of consciousness or Syncope
• Sever Vomiting
• Severe diarrhea
• Dehydration
• Confusion
• Psychosis

Adrenocortical Insufficiency – Treatment

The diagnosis of this disease is established after a series of tests have been done, and these tests include: CRH (corticotropin releasing hormone) and ACTH (adrenocorticotropic hormone which is produced by the pituitary gland) tests. The treatment of Adrenocortical Insufficiency is based on the replacement of the insufficient hormones from the body, with combinations of mineralocorticoids and glucocorticoids or fludrocortisone and hydrocortisone. The dose of these combinations is usually established by the doctor, and the dose is raised only in the case of surgery, forms of stress, pregnancy or trauma. The treatment with these hormones is oral, based on tablets. The cortisol is usually substituted with prednisone or cortisone, while the lack of aldosterone is replaced with fludrocortisone (this helps in controlling the levels of potassium and sodium in the body). The androgen insufficiency is treated with an androgen substitute known as dehydroepiandrosterone.

In the case of severe or chronic Adrenocortical Insufficiency (also known as Addisonian crisis, which is life threatening due to the low blood pressure and glucose and the high levels of potassium), the treatment is made intravenously with cortisone (hydrocortisone), glucose (dextrose, sugar) and saline solution.
Patients are recommended not to skip doses if they are suffering from Adrenocortical Insufficiency, because life-threatening reactions can appear. If patients can not keep the medication because they experience severe vomiting, they should announce their doctor and he will know what has to be done. Patients should also announce their personal healthcare provider if they experience sudden weight gain and fluid retention.
The home treatment is very important in patients with Adrenocortical Insufficiency problems. Here are a few advices:

• Do not skip doses
• Patients should use salt in their daily meals
• Announce their doctor if they develop the symptoms of an adrenal crisis, but also take their prescribed medications in such cases.
• Patients should have identification cards which show that they have this disease, as it is useful for the doctors to decide if either to make them a cortisol injection or not, while they are unconscious.
• Patients should monitor their weight and blood pressure. High blood pressure and swelling are signs that the treatment they take needs changes.

In patients with hemochromatosis, the treatment usually consists of removing the patient’s blood (procedure named phlebotomy) on a regular basis. The treatment’s goal is to reduce the iron levels, to bring them to normal. The quantity of removed blood depends on the patient’s health, iron overload, age and severity. Women who are pregnant are treated with the same replacement therapy, and in the case they experience vomiting and they can not retain the drug in the organism, then the same treatment is applied, but this time by injections. Patients who suffer from Adrenocortical Insufficiency and need surgery are treated also intravenously. The treatment begins with a day before the surgery and continues until the patient wakes from the anesthesia and can take the medication alone. The dose in such cases is established by the patient’s doctor.