Cortisol, a naturally-occurring corticosteroid hormone, is produced by your adrenal glands, which are situated atop the kidneys. It helps control your blood's sugar levels, as well as blood pressure and circulation. Cortisol also plays a major role in your body's response to physical and emotional stress. Cortisol deficiencies can be life-threatening. Several conditions can impede the production of cortisol, thereby creating a need for replacement therapy with a synthetic form of the hormone.
Congenital Adrenal Hyperplasia
Children afflicted by congenital adrenal hyperplasia are born without an enzyme necessary for the adrenal glands to produce cortisol. Consequently, the adrenals produce more androgen, a male reproductive hormone. Boys with congenital adrenal hyperplasia generally do not show symptoms at birth, but may enter puberty early. In girls, the disorder may manifest itself through abnormal menstruation, facial hair and other masculine characteristics. People with congenital adrenal hyperplasia must take a synthetic form of cortisol for the duration of their lives.
Addison's Disease
Damage to the adrenal glands can lead to Addison's disease, a condition in which the cortex -- the outer section of the organ -- is unable to produce cortisol and other essential hormones. Addison's disease can result from disorders that cause the immune system to mistakenly destroy adrenal tissue, trauma to the adrenal glands that leads to excessive blood loss and from infections or cancer that spreads to the adrenals from other parts of the body.
Hypopituitarism
The production of cortisol and hormones in the adrenal glands is controlled by the pituitary gland, a small organ located at the base of the brain. Among the substances released by the pituitary gland is adrenocorticotropic hormone or ATCH, which in turn stimulates the production of cortisol in the adrenal cortex. Hypopituitarism, or pituitary insufficiency, occurs when the pituitary stops producing one or more hormones. In addition to addressing the underlying cause of hypopituitarism, which can include a tumor, stroke, brain infection or injury, cortisol replacement therapy is a necessary component of treatment when the pituitary fails to produce adequate quantities of ATCH.
Adrenalectomy
Cortisol replacement therapy is needed when a person must have one or both adrenal glands surgically removed. Adrenalectomies are performed to extirpate cancerous tumors or even benign masses, which can sometimes secrete excess hormones. Doctors may also remove the adrenal glands to control Cushing's disease, a condition in which the pituitary gland produces too much ATCH, resulting in excessive cortisol. Cushing's disease can be caused by a pituitary tumor or induced by prolonged use of oral corticosteroids for other conditions.
References
- Great Ormond Street Hospital for Children: Cortisol Deficiency and Steroid Replacement Therapy
- Seattle Children's Hospital: Cortisol Replacement Therapy
- MayoClinic.coml Stress - Constant Stress Puts Your Health at Risk; September 2010
- PubMed Health: Congenital Adrenal Hyperplasia
- MedlinePlus: Hypopituitarism
- MayoClinic.com; Addison's Disease; June 2010
- PubMed Health: Addison's Disease
- MayoClinic.com; Cushing's Syndrome; September 2010
- Aurora Health Care: Adrenalectomy - Open Surgery
