The adrenal glands are located on top of the kidneys and are responsible for making certain hormones, including cortisol (which modulates the body's stress response) and aldosterone (which controls salt and water balance). The adrenal glands are controlled by the pituitary gland. Problems with the adrenal glands or the pituitary can impair adrenal function, leading to adrenal insufficiency.
Types
Adrenal insufficiency syndrome is the result of the adrenal glands not producing enough of certain hormones. There are two different kinds of adrenal insufficiency, according to the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK). Primary adrenal insufficiency is the result of the adrenal glands themselves being damaged, causing them to not produce enough adrenal hormones. Secondary adrenal insufficiency is the result of the adrenal glands being healthy but not being stimulated to make adrenal hormones, possibly due to a problem with the pituitary.
Symptoms
The symptoms of adrenal insufficiency can develop gradually, the Journal of the American Medical Association explains. They include muscle weakness, loss of appetite, weight loss and chronic fatigue. Patients may also have gastrointestinal symptoms, which can include nausea, vomiting and diarrhea. Patients may also experience darkening of their skin, pain in their joints and abdomen and cravings for salt.
Addison's
Addison's disease is another term for primary adrenal insufficiency. It can be the result of an autoimmune disorder, notes the NIDDK. With autoimmune diseases, the immune system inadvertently attacks normal human tissue (such as the adrenal glands). Addison's disease can also be caused by tuberculosis because this infection can destroy the adrenal glands.
Diagnosis
Adrenal insufficiency is typically diagnosed using blood tests that measure the levels of cortisol and aldosterone, which are two hormones that are commonly under-produced in patients with adrenal insufficiency. Primary and secondary adrenal insufficiency can be distinguished using the ACTH stimulation test. ACTH is a pituitary hormone that stimulates the adrenal glands' production of cortisol. Patients' cortisol levels are measured before and after they are injected with ACTH. Patients with primary adrenal insufficiency will have little or no increase in their cortisol production after ACTH stimulation.
Treatment
Adrenal insufficiency, according to the Clinical Center at the National Institutes of Health, is usually treated using synthetic hormones. Dexamethasone or prednisone are often prescribed to supplement cortisol levels. Patients with reduced levels of aldosterone may need to take another medication called fludrocortisone. When patients taking these medications are ill or under significant physical or emotional stress, they may need to take more of these medications because of the body's increased need for adrenal hormones when stressed.
