Adrenal Insufficiency

Adrenal Insufficiency – General Information

The Adrenal Insufficiency (also known as hypocortisolism) is the inability of the adrenal glands to produce the normal levels of hormones, and in some cases aldosterone in stress conditions, and can appear as a primary or secondary disorder, the last form in more common. This disease can be congenital, but can also be acquired and it affects more women than men. The Adrenal Insufficiency varies in the grade of severity and in symptoms. The first conditions can appear in patients who have autoimmune polyglandular syndromes, (such as diabetes, hypothyroidism, and autoimmune thyroid disorder).
The causes of Adrenal Insufficiency are the followings:

• Addison’s disease
• Septic shock –is a medical condition due to the decreased tissue perfusion and oxygen delivery. It is usually a result of sepsis or infection and it can be deadly.
• Waterhouse- Friderichsen syndrome – is a medical condition characterized by a hemorrhage of the adrenal glands.
• Addisonian crises, which appear if the patients that are under treatment with corticosteroids have a surgical intervention or if the patients interrupt the corticosteroid treatment.
• Congenital Adrenal Hyperplasia - is a medical condition characterized by a rise or decrease in the levels of sex steroids.
• Antiphospholipid Syndrome - is a medical condition characterized by problems with the blood coagulation in veins and arteries.
• Haemochromatosis
• Isolated corticotropin deficiency
• Mycobacterium tuberculosis – is the bacteria which causes the tuberculosis.
• Adrenoleucodystrophy – is a rare medical condition, which can be inherited and it leads to progressive brain damage.
• Autoimmune polyendocrine syndrome I
• Lipoid congenital adrenal hyperplasia

Adrenal Insufficiency – Symptoms

It is well known that any medical disorder (including Adrenal 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 Adrenal Insufficiency or from any other medical disorder.
Here is a list of the most common symptoms of the Adrenal Insufficiency:

• Inability to concentrate
• Excessive fatigue
• Nervousness and irritability
• Mental depression
• Apprehensions
• Excessive weakness
• Lightheadedness
• Faintness and fainting
• Insomnia
• Anorexia
• Hypotension
• Nausea 
• Vomiting
• Reflexes are exaggerated, especially the deep tendon ones.
• Swelling
• Pain
• Tenderness
• Thin, dry or scaly skin
• Pigmentation of temples
• Red palms and fingertips
• Cold clammy palms
• Low blood pressure
• Asthenic habitus
• Sparse hair
• Crowded lower teeth
• Frequent urination with small quantities of urine or rare urination with high quantities.
• Scanty perspiration
• Swelling of the ankle and fingers
• Goiter
• Vitiligo
• Excessive facial hair
• Irregular period
• Infertility that is caused by the anovulation
• Hypertension
• Malaise
• Liver cirrhosis
• Hypogonadism
• Arthritis of the joints, shoulder, knee, and hands.
• Possible deafness
• Possible dysfunctions of the following glands:
• Pancreatic gland
• Parathyroid gland
• Pituitary gland
• Testes glands
• Ovary glands

Adrenal Insufficiency – Treatment

The Adrenal Insufficiency is a life threatening emergency and it needs immediate treatment, especially when there are suspicions or symptoms, the patients should be put under treatment as fast as possible. The scope of the therapy is to treat the underlying cause, especially in patients who have hypotension, cortisol deficiencies and electrolyte abnormalities. The major manifestations in patients who suffer from Adrenal Insufficiency are hyponatremia and hyperkalemia. The first one is treated with antidiuretic hormone, also known as ADH, which leads to water retention and reduces the concentration of sodium from the plasma. Aldosterone and cortisol deficiency contribute to the problem as following:

• The aldosterone deficiency leads to hypersecretion of ADH which can cause an adrenal crisis.
• The cortisol deficiency also leads to hypersecretion of ADH, as a result of the decreased systemic blood pressure (which is caused by the lack of cortisol) and can cause an adrenal crisis.

This type of hyponatremia is usually found in primary Adrenal Insufficiency, and less often in secondary and tertiary forms. Hyperkalemia is caused by hypoaldosteronism, in Adrenal Insufficiency, as the primary function of the aldosterone is to favor the urinary excretion.
In the case of septic shock the scopes of the treatment are:

• Volume resuscitation
• Identification of the source and control
• Antibiotic treatment
• Help in major organ dysfunctions.

In patients in whom the Adrenal Insufficiency is caused by the Waterhouse- Friderichsen syndrome the treatment is based on antibiotics. Here is a list of possible antibiotics that can be prescribed in such cases:

• Benzylpenicillin
• chloramphenicol
• Hydrocortisone
• Ceftriaxone

In patients who have Addison crisis the treatment is based on the replacement of the cortisol that lacks and it is usually an oral treatment. The dose of the cortisol will be established by the patient’s doctor. Such drugs are hydrocortisone or fludrocortisone.
In the case of Congenital adrenal hyperplasia the scope of the treatment is to ensure the needed quantity of glucocorticoids to the organism. In women who have ambiguous genitalia (meaning that the external genitals do not appear clearly female or male) plastic surgery may be needed.
In patients with antiphospholipid syndrome, the treatment is based on the symptoms, which are different among patients. Patients are usually prescribes aspirin, because aspirin prevents the appearance of blood clots, but in the cases that they appear then the patient will be recommended to take anticoagulant drugs, such as:

• Warfarin
• Enoxaparin

In patients with Haemochromatosis, if the disease is not diagnosed in time, they have to follow the following treatments:

• To treat the possible organs damage that may appear.
• To increase the dose of the substance that assures the inhibition of iron absorption.

In patients with Adrenoleucodystrophy there is no cure, no way to get rid of it and the treatment is based on the amelioration of the symptoms. The treatments are usually dietary, and can include Lorenzo’s Oil, but the bone marrow transplant may also help in patients who have mild symptoms.