Adrenal insufficiency is marked by decreased levels of activity of the adrenal gland. The adrenals are responsible for mineralocorticoid production (aldosterone), glucocorticoid production (cortisol) and androgen production (a type of sex hormone). Thus, deficiency in adrenal function can have a wide array of complications, affecting many different body systems.
General Symptoms
Patients with adrenal dysfunction tend to have nonspecific complaints such as fatigue, weight loss and a general feeling of malaise. These tend to occur in almost every patient with adrenal insufficiency.
Adrenal Crisis
Adrenal crisis is a medical emergency. The patient presents with decreased blood pressure (hypotension) and collapse of the circulatory system. Decreased blood sugar, abdominal pain, increased potassium and an acidic state are usually all present as well. The patient needs urgent treatment, which usually involves replenishment of adrenal hormones such as aldosterone and cortisol.
Dizziness
Dizziness can occur in adrenal insufficiency, especially upon standing. This is known by the medical term "orthostatic hypotension." Normally, when a person stands up, the blood tends to pool in the legs; however, a healthy person has enough blood volume to make this not noticeable. Aldosterone works at the level of the kidneys to retain fluid and sodium. When the adrenals are not producing enough aldosterone, the body tends to not have enough fluid in the blood vessels. Thus, when the blood pools in the legs, and there is not enough volume to compensate, the patient can suffer from dizziness and falls.
Decreased Blood Sugar Levels
Cortisol is one of the hormones that is released by the adrenal glands in times of stress. It mobilizes glucose stores into the bloodstream for use by the body. Thus, when the adrenals are producing less cortisol, there are lower levels of sugar in the blood, which can result in the general feelings of fatigue and weakness most patients feel.
Hormonal Complications
The adrenal glands release androgens, which are sex hormones that affect male characteristics but are also converted into estrogen. As a result of their decreased production, different symptoms can manifest, depending on the gender of the patient. Males tend to suffer from decreased testes size, decreased libido, gynecomastia (abnormally large male breasts) and impotence; females will have decreased hair in the pubic region and armpits (axillary region).
Electrolyte Disturbances
Aldosterone works by acting on the kidneys to increase fluid and sodium reabsorption into the bloodstream. It also causes the body to excrete potassium ions and acidic hydrogen ions. Decreased aldosterone production thus causes the opposite effects to occur in the body, such as decreased fluid and sodium, and increased potassium and acidic hydrogen ions. Increased potassium has dangerous effects on the heart and can cause muscle weakness; decreased sodium levels can cause mental status changes; and decreased blood volume can have far reaching consequences (such as the dizziness described above). Also, an acidic state can exist in the body, which can also have toxic effects on the body.
Gastrointestinal Complications
Patients commonly tend to complain of issues with the gastrointestinal system. Diarrhea, nausea, vomiting, constipation and abdominal pain are common complaints, and can be attributed to a variety of causes, such as the electrolyte disturbances mentioned above.
References
- "Williams Textbook of Endocrinology, 11th Edition;" Kronenberg; 2008
- "Critical Care Medicine"; Diagnosing adrenal insufficiency; Alaniz, C., Hyzy, R.; December 2008
- National Endocrine and Metabolic Diseases: Adrenal Insufficiency
