Adrenal insufficiency is an endocrine, or hormonal, disorder that occurs when the adrenal glands do not produce enough of certain hormones. The adrenal glands are located just above the kidneys. Adrenal insufficiency can be primary or secondary, type 1 diabetes and adrenal function. The adrenal hormone aldosterone may also be lacking.
Secondary adrenal insufficiency occurs when the pituitary gland—a pea-sized gland at the base of the brain—fails to produce enough adrenocorticotropin ACTHtype 1 diabetes and adrenal function, a hormone that stimulates the adrenal glands to produce the hormone cortisol.
If ACTH output is too low, cortisol production drops. Eventually, the adrenal glands can shrink due to lack of ACTH stimulation. In addition, the body uses the adrenal hormone dehydroepiandrosterone DHEA to make androgens and estrogens, the male and female sex hormones. Cortisol belongs to the class of hormones called glucocorticoids, which affect almost every organ and tissue in the body.
Among its many tasks, cortisol helps. The amount of cortisol produced by the adrenal glands is precisely balanced. Like many other hormones, cortisol is regulated by the hypothalamus, which is a part of the brain, and the pituitary gland. ACTH stimulates the adrenal glands to produce cortisol. Cortisol then signals back to both the pituitary gland and hypothalamus to decrease these trigger hormones. Aldosterone belongs to the class of hormones called mineralocorticoids, also produced by the adrenal glands.
Aldosterone helps maintain blood pressure and the balance of sodium and potassium in the blood. When aldosterone production falls too low, the body loses too much sodium and retains too much potassium. The decrease of sodium in the blood can lead to a drop in both blood volume—the antibiotics used for adult ear infections of fluid in the blood—and blood pressure.
Too little sodium in the body also can cause a condition called hyponatremia. Symptoms of hyponatremia include feeling confused and fatigued and having muscle twitches and seizures. Too much potassium in the body locally advanced prostrate cancer t3 lead to a condition called hyperkalemia.
Hyperkalemia may have dilantin after surgery symptoms; however, it can cause irregular heartbeat, nausea, and a slow, weak, or an irregular pulse. The body uses DHEA to make the sex hormones, androgen and estrogen.
With adrenal insufficiency, the adrenal glands may not make enough DHEA. Healthy men derive most androgens from the testes. Healthy women and adolescent girls get most of their estrogens from the ovaries. However, women and adolescent girls may have various symptoms from DHEA insufficiency, such as loss of pubic hair, dry skin, a reduced interest in sex, and depression. This darkening is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and toes; lips; and mucous membranes such as the lining of the cheek.
The slowly progressing symptoms of adrenal insufficiency are often ignored until a stressful event, such as surgery, a severe injury, type 1 diabetes and adrenal function, an illness, or pregnancy, causes them to worsen. Sudden, severe worsening of adrenal insufficiency symptoms is called adrenal crisis. In most cases, symptoms of adrenal insufficiency become serious enough that people seek medical treatment before an adrenal crisis occurs.
However, sometimes symptoms appear for the first time during an adrenal crisis. Infections and medications may also cause the disease. Primary adrenal insufficiency occurs when at least 90 percent of the adrenal cortex has been destroyed.
Sometimes only the adrenal glands are affected. Sometimes other endocrine glands are affected as well, as in polyendocrine deficiency syndrome. Polyendocrine deficiency syndrome is classified into type 1 and type 2. Type 1 is inherited and occurs in children. In addition to adrenal insufficiency, these type 1 diabetes and adrenal function may have. Type 2 usually affects young adults and may include. Thomas Addison inTB was the most common cause of the disease.
The lack of these hormones in the body can be traced to several possible sources. A temporary form of secondary adrenal insufficiency may occur when a person who has been taking a synthetic glucocorticoid hormone, called a corticosteroid, for a long time stops taking the medication.
Corticosteroids are often prescribed to treat inflammatory illnesses such as rheumatoid arthritis, asthma, and ulcerative type 1 diabetes and adrenal function. In this case, the prescription doses often cause higher levels than those normally achieved by the glucocorticoid hormones created by the body.
When a person takes corticosteroids for prolonged periods, the adrenal glands produce less of their natural hormones. To give the adrenal glands time to regain function and prevent adrenal insufficiency, prescription corticosteroid doses should be reduced gradually over a period of weeks or even months.
Even with gradual reduction, the adrenal glands might not begin to function normally for some time, type 1 diabetes and adrenal function, so a person who has recently stopped taking prescription corticosteroids should be watched carefully for symptoms of secondary adrenal insufficiency. The adrenal glands might not begin to function normally for some time, so a person who has had an ACTH-producing tumor removed and is going off of his or her prescription corticosteroid replacement hormone should be watched carefully for symptoms of adrenal insufficiency.
Less commonly, secondary adrenal insufficiency occurs when the pituitary gland either decreases in size or stops producing ACTH. These events can result from. In its early stages, adrenal insufficiency can be difficult to diagnose. A diagnosis of adrenal insufficiency is confirmed through hormonal blood and urine tests. A health care provider uses these tests first to determine whether cortisol levels are too low and then to establish the cause.
Imaging studies of the adrenal and pituitary glands can be useful in helping to establish the cause. Although a reliable diagnosis is not possible during adrenal crisis, measurement of blood ACTH and cortisol during the crisis—before treatment with corticosteroids is given—is often enough to make a preliminary diagnosis. Low blood sodium, low blood glucose, and high blood potassium are also sometimes present at the time of adrenal crisis. Once the crisis is controlled, an ACTH stimulation test can be performed to help make a specific diagnosis.
More complex lab tests are sometimes used if the diagnosis remains unclear. After secondary adrenal insufficiency is diagnosed, health care providers may use the following tests to obtain a detailed view of the pituitary gland and assess how it is functioning:. Adrenal insufficiency is treated by replacing, type 1 diabetes and adrenal function, or substituting, the hormones that the adrenal glands are not making.
The dose of each medication is adjusted to meet the needs of the patient. Cortisol is replaced with a corticosteroid, type 1 diabetes and adrenal function as hydrocortisone, prednisone, or dexamethasone, taken orally type 1 diabetes and adrenal function to three times each day, depending on which medication is chosen.
If aldosterone is also deficient, it is replaced with oral doses of a mineralocorticoid hormone, called fludrocortisone acetate Florineftaken once or twice daily. People with secondary adrenal insufficiency normally maintain aldosterone production, so they do not require aldosterone replacement therapy. During adrenal crisis, low blood pressure, low blood glucose, low blood sodium, and high blood levels of potassium can be life threatening.
Standard therapy involves immediate IV injections of corticosteroids and large volumes of IV saline solution with dextrose, a type of sugar. This treatment usually brings rapid improvement. When the patient can take liquids and medications by mouth, the amount of corticosteroids is decreased until a dose that maintains normal hormone levels is reached.
If aldosterone is deficient, the person will need to regularly take oral doses of fludrocortisone acetate. Researchers have found that using replacement therapy for DHEA in adolescent girls who have secondary adrenal insufficiency and low levels of DHEA can improve pubic hair development and psychological stress.
Further studies are needed before routine supplementation recommendations can be made. Problems can occur in people with adrenal insufficiency who are undergoing surgery, suffer a severe injury, have an illness, or are pregnant.
These conditions place additional stress on the body, and people with adrenal insufficiency may need additional treatment to respond and recover. People with adrenal insufficiency who need any type of surgery requiring general anesthesia must be treated with IV corticosteroids and saline.
IV treatment begins before surgery and continues until the patient is fully awake after surgery and is able to take medication by mouth. In addition, people who are not currently taking corticosteroids, yet have taken long-term corticosteroids in the past year, should tell their health care provider before surgery. These people may have sufficient ACTH for normal events; however, they may need IV treatment for the stress of surgery. Often, these stress doses must be given intravenously.
Once the patient recovers from the injury, dosing is returned to regular, pre-injury levels. During an illness, a person taking corticosteroids orally may take an adjusted dose to mimic the normal response of the adrenal glands to this stress type 1 diabetes and adrenal function the body.
Significant fever or injury may require a triple dose. Once the person recovers from the illness, dosing is then returned to regular, pre-illness levels.
People with adrenal insufficiency should know how to increase medication during such periods of stress, as advised by their health care provider. Immediate medical attention is needed if severe infections, vomiting, or diarrhea occur. These conditions can lead to an adrenal crisis, type 1 diabetes and adrenal function.
Women with adrenal insufficiency who become pregnant are treated with the same hormone therapy taken prior to pregnancy. However, if nausea and vomiting in early pregnancy interfere with taking medication orally, injections of corticosteroids may be necessary.
During delivery, type 1 diabetes and adrenal function, treatment is similar to that of people needing surgery. Following delivery, the dose is gradually lessened, and the regular dose is reached about 10 days after childbirth. Adrenal crisis type 1 diabetes and adrenal function treated with adrenal hormones. People with adrenal crisis need immediate treatment.
Any delay can cause death. When people with adrenal crisis are vomiting or unconscious and cannot take their medication, type 1 diabetes and adrenal function, the hormones can be given as an injection.
For example, a child younger than 2 years of age can receive 25 milligrams mga child between 2 and 8 years of age can receive 50 mg, and a child older than 8 years should receive the adult dose of mg. A card or medical alert tag should notify emergency health care providers of the need to inject corticosteroids if the person is found severely injured or unable to answer questions.
People with adrenal insufficiency should always carry a needle, a syringe, and an injectable form of corticosteroids for emergencies. A health care provider or a dietitian can give specific recommendations on appropriate sodium sources and daily sodium guidelines if necessary. Corticosteroid treatment is linked to an increased risk of osteoporosis—a condition in which the bones become less dense and more likely to fracture.