The adrenal glands, which are situated on top of the kidneys, are responsible for producing hormones that help the body work properly. In adrenal insufficiency, the adrenal glands do not make adequate amounts of the hormones cortisol and aldosterone. These two hormones are essential for certain processes in the body, like blood pressure and fluid balance.
Functions
Cortisol is a glucocorticoid hormone made by the adrenal glands that plays several roles in the body. The National Endocrine and Metabolic Diseases Information Service reports that the most important function of cortisol is helping the body respond to stress, such as an infection, surgery or illness. Other functions of cortisol include maintaining blood sugar levels for energy and proper functioning of the heart and blood pressure.
Aldosterone belongs to a class of adrenal hormones known as mineralocorticoids. Its job is to regulate the amount of sodium, potassium and fluid in the body. It stimulates the kidneys to retain sodium and excrete potassium.
Types
Adrenal insufficiency may be temporary or permanent. Permanent adrenal insufficiency could be caused by problems with the adrenal glands or the pituitary gland in the brain. When adrenal insufficiency is the result of adrenal issues such as a tumor in the adrenal glands or destruction of the adrenal glands, it is called primary adrenal insufficiency or Addison's disease.
The pituitary glands release a hormone called ACTH that stimulates the adrenal glands to secrete cortisol. When ACTH levels in the body go down, production of cortisol by the adrenal glands drop as well. Secondary adrenal insufficiency occurs when the pituitary glands make little quantities of ACTH due to pituitary tumors or other pituitary disorders. The University of California San Francisco Medical Center states that surgery, infection or physical stress can cause temporary adrenal insufficiency.
Symptoms
Symptoms of adrenal gland insufficiency often begin slowly. Initial symptoms of this disorder are dizziness that occurs when standing due to low blood pressure, muscle weakness, fatigue that keeps getting worse, loss of appetite, pain in the stomach, nausea, vomiting and diarrhea. Darkening of the skin is also a symptom of Addison's disease, but not secondary adrenal insufficiency.
Treatment
Treatment for adrenal insufficiency involves hormone replacement therapy, in which absent or insufficient adrenal hormones are replaced by synthetic hormones. Cortisol can be replaced by several synthetic hormones such as hydrocortisone, dexamethasone and prednisone. People with secondary adrenal insufficiency may not need hormone replacement for aldosterone. This is because aldosterone levels may be sufficient for the body to work properly. However, if aldosterone is absent, it can be replaced with fludrocortisone acetate.
Considerations
Persons with adrenal insufficiency need to take certain precautions. Before undergoing surgery, a person with adrenal insufficiency needs to be treated with intravenous glucocorticoids and saline. Also, during periods of illness, doses of adrenal insufficiency medication should be increased, because cortisol helps the body cope with illness.
