The adrenal glands, located on top of the kidneys, work with the hypothalamus and pituitary glands to produce the hormones cortisol and aldosterone. According to the National Endocrine and Metabolic Diseases Information Services, cortisol affects almost every tissue and organ in the body. Its main function is to help the body deal with stress, but also plays a role in maintaining blood pressure, cardiovascular function, immune system response, glucose regulation and metabolism of proteins, carbohydrates and fats. Aldosterone is necessary for blood pressure maintenance and water and salt balance. Adrenal insufficiency is a condition that occurs when the adrenal glands fail to produce enough of these hormones.
Primary vs Secondary Adrenal Insufficiency
Adrenal insufficiency is classified as either primary or secondary. Primary adrenal insufficiency, also known as Addison's disease, is a condition characterized by damaged adrenal glands that are unable to produce enough cortisol and often aldosterone. Secondary adrenal insufficiency, which is more common than primary, occurs when the pituitary gland does not produce enough of the hormone adrenocorticotropin (ACTH) which is responsible for stimulating the production of cortisol from the adrenal glands. With limited production of ACTH, cortisol levels drop and, after time, the adrenal glands shrink.
Causes
Adrenal Insufficiency can be caused by several factors: Autoimmune disorders, infection, cancer, trauma, congenital adrenal hyperplasia and surgical removal of pituitary or adrenal glands. Adrenal Insufficiency can also be a temporary condition caused by long-term steroid use, cortisol lowering drugs for Cushing Syndrome and adrenal gland tumor removal.
Hypoglycemia
Various symptoms are associated with adrenal insufficiency such as fatigue, weakness, loss of appetite, nausea and vomiting, but hypoglycemia may be one of the most dangerous. Primary and secondary adrenal insufficiency are characterized by low cortisol levels. Because of this, blood glucose, the body's main energy source, is not efficiently regulated and may drop to dangerously low levels. Hypoglycemia in adrenal insufficiency is seen more commonly in children.
Hypoglycemia Symptoms/Complications
If the body's cells are deprived of glucose, the body goes into starvation mode. According to the Mayo Clinic, symptoms of hypoglycemia include confusion, inability to perform routine tasks, blurred or double vision, heart palpitations, tremors, anxiety, sweating and hunger. If these symptoms are ignored, seizure, loss of consciousness and death may result.
Treatment
According to the National Institutes of Health, adrenal insufficiency is managed with daily hormone replacement drugs. Hydrocortisone, dexamethasone or prednisone are synthetic glucocorticoids that may be prescribed to act as a cortisol substitute. For those with insufficient aldosterone, this hormone is replaced with flludrocortisone acetate, which may require an increase in salt consumption. During an Addisonian crisis, a life-threatening condition characterized by hypoglycemia and low blood pressure accompanied by high potassium levels, immediate intravenous injections of glucocorticoids and intravenous saline and dextrose solutions are required. After recovery, glucocorticoid and mineralcorticoid amounts are reduced to maintenance doses.
