Pyramid shaped structures that lie on top of the kidneys, the adrenal glands, control the body's response to stress, blood pressure, metabolism and immune system. Hormones produced by the adrenal gland are the steroid hormones cortisol, aldosterone and androgens. Adrenal insufficiency (AI) occurs when there is production failure of one or more steroid hormones. The most common cause of failure in western society is autoimmune destruction of the gland. Most symptoms associated with adrenal failure are non-specific and may be overlooked early in disease.
Weakness
Involved in the body's energy regulation, adrenal failure due to a decreased production of cortisol causes fatigue. Decreased production of glucose hamper's the body's ability to maintain its energy needs. This cortisol deficiency causes an overall general deficit in energy metabolism which results in the patient experiencing weakness, according to the Merck Manual. Poor metabolism in the heart muscle leads to a decrease in cardiac output. An inability to deliver blood to tissues sufficiently also impairs the body's ability to meet energy requirements.
Paresthesia
Failure of the adrenal glands also leads to abnormalities in electrolytes such as calcium and potassium. Shifts in these elements can cause nerve irritability. Hypercalcemia is often associated with paresthesias, the clinical definition for tingling of fingers and toes. Noted for the development of hypercalcemia, adrenal insufficiency may have similar or related symptoms. Correction of electrolyte abnormalities can improve these symptoms.
Cramping
Electrolyte abnormalities are the most likely cause of many of the symptoms associated with adrenal insufficiency. Adrenal insufficiency is known for development of abnormalities in sodium, potassium and calcium. Calcium is directly involved in muscle contractions. Disruption of calcium hemostasis or balance may lead to abnormalities in muscle contraction, causing pain or cramping.
Stress Intolerance
One of the major roles of the adrenal gland is to control the body's response to stress. Failure of the adrenals to produce cortisol in sufficient interrupts the body's ability to handle stress appropriately. Stressors that can cause the worsening of adrenal symptoms include major trauma and infections.
Personality Changes
Irritability and restlessness are commonly associated with adrenal insufficiency. The brains ability to handle the external environment is decreased when cortisol is decreased. Other factors include decreased blood volume and electrolyte abnormalities. Personality is affected by a combination of these changes due to adrenal insufficiency.
Hyperpigmentation
Melanin is increased in the upper layer of the skin due to a decrease in cortisol's control. Areas with dark coloring may become noticeably darker. Mostly affecting darker complected people, this phenomenon may also be seen in those with fairer skin.
Arterial Hypotension
Cortisol has a direct affect on vascular tone. It acts on smooth muscle in the blood vessels to help maintain blood pressure. Absence of cortisol causes a fluctuation or decrease in blood pressure. Extreme hypotension is seen as adrenal crisis. If there is a deficiency in aldosterone, sodium reduction also plays a role in blood pressure maintenance and regulation. Dehydration results from the lack of volume. Together this results in circulatory insufficiency.
Gastrointestinal Abnormalities
Nausea, vomiting, anorexia, diarrhea and abdominal pain are common symptoms associated with adrenal insufficiency. These symptoms occur mainly due to the lack of the stress hormone, cortisol. The gastrointestinal system is affected by circulatory and electrolyte regulation due to its vascularity and the presence smooth muscle throughout the digestive tract. Severe vomiting may further worsen dehydration.
Craving of Salty Foods
Due to salt loss from aldosterone insufficiency, craving for salty foods may also occur.
