Adrenal insufficiency is a disorder of the adrenal glands, which are located just above the kidneys, in which they do not produce enough of certain hormones. Adrenal insufficiency can be called Addison's disease or hypocortisolism, and it occurs in all ages, affects both sexes and can be life-threatening. Treatment for adrenal insufficiency includes the use of steroids.
Types
Primary adrenal insufficiency, or Addison's disease, occurs when damaged adrenal glands cannot produce enough of the hormone cortisol, and sometimes the hormone aldosterone. Secondary adrenal insufficiency describes under-active adrenal glands due to insufficient stimulation from the pituitary gland. Secondary adrenal insufficiency is far more prevalent than Addison's disease, notes the National Endocrine and Metabolic Disease Information Service, or NEMDIS
Causes
In upwards of 70 percent of the cases of Addison's disease the cause is unknown, but some autoimmune reaction, where the body's immune system attacks and destroys the adrenal cortex, is at work, notes NEMDIS. In the remaining cases, the adrenal glands are destroyed by cancer, infection like tuberculosis, or some other disease. In infants and children, a genetic abnormality of the adrenal glands may be the cause of Addison's disease.
Symptoms
The symptoms of adrenal insufficiency usually begin gradually and include fatigue, muscle weakness, loss of appetite and weight loss. People with Addison's disease tend to develop patches of dark skin, like black freckles on the forehead, face, and shoulders, and bluish-black discoloration around the nipples, lips, mouth, rectum, scrotum, or vagina. Other symptoms include nausea, vomiting, low blood pressure causing dizziness when standing, headaches and sweating. Especially in children, nervousness, extreme hunger for salty foods and hypoglycemia can occur.
Lack of Cortisol Treatment
The treatment for adrenal insufficiency is to replace or substitute the hormones that the adrenal glands are not making. Cortisol is a hormone that helps the body cope with stress. Cortisol is replaced with synthetic glucocorticoids, and this treatment is required for life. Hydrocortisone, a corticosteroid, can be taken orally daily, at a dosage between 20 and 35 mg. An emergency self injection of hydrocortisone can also be prescribed, to be administered during stressful situations. Prednisone is another corticosteroid that is administered orally, usually at a dosage of 7.5 mg. Finally, dexamethasone is another corticosteroid that is most commonly administered at a dosage of 0.25 mg. Occasionally, a dosage of 0.5 to 1 mg may be prescribed, but this tends to result in side effects similar to Cushing's disease, a disorder where the body has too much cortisol.
Lack of Aldosterone Treatment
Aldosterone is a hormone responsible for the reabsorption of sodium and water and the release of potassium in the kidneys, which increases blood volume, and therefore pressure. If aldosterone levels are low it is frequently replaced by fludrocortisone, a corticosteroid, which is a potent mineralocorticoid. Patients receiving this therapy are typically advised to increase their salt intake. Fludrocortisone is available in 0.1 mg tablets; normal daily doses for mineralocorticoid replacement therapy are 0.05 mg to 0.2 mg. Blood tests can help to verify and establish correct dosing.
Considerations
Untreated Addison's disease can result in an "adrenal crisis" accompanied by severe abdominal pains, intense weakness, dangerously low blood pressure, kidney failure, and shock. These acute adrenal crises occur most commonly when the body is in under stress, commonly from an accident, injury, surgery, or severe infection, and death may quickly result. A medical identification card that states the type of medication and the proper dose needed in case of an emergency should be carried by the patient, and a medical alert bracelet should be worn.
