1. When the Hormone Factory Shuts Down
Sitting above each kidney is an adrenal gland. These glands are part of the lymphatic system and are responsible for producing cortisol, a hormone that has many vital functions including maintaining blood pressure, slowing the inflammation response of the immune system and regulating the metabolism of carbohydrates, fats and proteins. Its main function is to respond to stress. Adrenal insufficiency results when these glands do not produce enough cortisol (and, in some cases, aldosterone as well). This is also called Addison's disease or hypocortisolism. It affects both men and women at a rate of about one in every 100,000.
2. Insufficient Adrenal Production Leaves its Mark
Adrenal insufficiency is most commonly indicated by fatigue, muscle weakness, weight loss, low blood pressure (low enough to cause dizziness or fainting upon standing) and low blood sugar (hypoglycemia). Darkening of the skin (hyperpigmentation) may also be noted. If aldosterone is affected, loss of salt can lead to a craving for salty foods. Changes in menstruation may also be seen. In nearly half of cases, nausea, diarrhea and vomiting may occur. All of these symptoms do not appear suddenly, but develop over time.
3. Why the Adrenal Glands May Go on Strike
There are two main reasons why the adrenal glands may stop producing cortisol: damage to the adrenal glands themselves (caused mostly by the body's immune system destroying the outer layer of the glands), referred to as primary adrenal insufficiency, or by a problem with the pituitary gland, which is responsible for secreting adrenocorticotropin (ACTH) needed to stimulate the adrenal glands. The latter cause is called secondary adrenal insufficiency. Much less commonly, disease (such as tuberculosis) or infection may cause the adrenal glands to stop working properly.
4. A Test for Your Hormones
At first, a diagnosis of adrenal insufficiency can be difficult to reach. The early symptoms may be signs of another disease. One of the main tests for adrenal insufficiency is an ACTH Stimulation Test, wherein synthetic ACTH is injected into the body and cortisol levels are tested in the blood and urine within 30 to 60 minutes. Low levels or no response is indicative of adrenal insufficiency. Abnormal results of an insulin-induced hypoglycemia test, which uses injected insulin to gauge the body's stress response, also strongly suggests adrenal insufficiency.
5. Getting Back on Track
The main focus of treatment for adrenal insufficiency is to replace the cortisol the adrenal glands is no longer producing; thus, hydrocortisone tablets need to be taken either once or twice daily. If production of aldosterone is also insufficient, fludrocortisone acetate is also taken once per day. Though this condition is not fatal, an episode of acute adrenal insufficiency (called an addisonian crisis) resulting in low blood pressure, severe diarrhea and vomiting and loss of consciousness can lead to death if left untreated.
