A Closer Look at Adrenal Insufficiency
Adrenal insufficiency is a medical condition that refers to the inability of the adrenal glands to produce enough hormones. The primary hormone involved is the cortisol. However, aldosterone may also be reduced in some cases of illness. Some experts classify the disorder as the inability of the person to cope with stressful situations. The terms addison’s disease and adrenal insufficiency are often used interchangeably. However, this is incorrect. Addison’s disease is only one part of adrenal insufficiency. There are other possible diseases classified under the broad category.
Epidemiology
The disorder is one of the most common imbalances nowadays. But if you think of Addison’s disease alone, it is a rare condition that only affects a small portion of the world’s population. It involves only 1 in every 100,000 population. It both affects males and females equally.
Overview
Adrenal glands are two glands found on top of the kidneys. They are responsible for the production of hormones that regulate the different processes in the body. Examples of these hormones are cortisol and aldosterone. Cortisol is important in the regulation of blood pressure and blood sugar level. It helps in the metabolism of fats and protein and it slows down the body’s response to inflammation. In order to keep the body in its normal state, the amount of cortisol should be well balanced.
On the other hand, aldosterone is crucial in the regulation of electrolyte in the body. It maintains the normal sodium and potassium blood level.
Pathophysiology
Normally, the cortisol is released in response to the stimulation of the pituitary gland. The gland secretes the hormone ACTH which in turn stimulates the adrenal gland to produce cortisol. In cases of adrenal insufficiency, the amount of cortisol produced is very low. The deficiency leads to the development of various symptoms.
Causes
There are several causes of the disorder. It may be due to genetic abnormalities or from environmental influences. Your genes, nutritional imbalances, the presence of toxins and environmental stress contribute to the depletion of the cortisol level in the body.
Types
Adrenal insufficiency comes in two types. It can either be a primary or a secondary disorder. In the primary type, the problem is due to the adrenal gland itself. About 70% of the cases are classified under this category. The immune system produces antibodies that attack its own cells and later on, destroys the tissues. The main cause of the problem is still unknown but there are theories that connect it to some infections. Tuberculosis, fungal infections and adrenal cancer are some contributory factors to the development of primary adrenal insufficiency.
With the secondary type, it involves the pituitary gland or the hypothalamus. These two endocrine glands fail to release the hormone needed to stimulate the adrenal glands. Oftentimes, the problem is due to the presence of tumor in any of these organs. Surgical removal of the tumor corrects the problem.
Symptoms
Symptoms of adrenal insufficiency are classified as mild to severe and even life threatening. The symptoms develop gradually and begin with mild problems like loss of appetite, dizziness, nausea, vomiting, muscle weakness, low energy level and body pains. If the problem is left untreated, the symptoms worsen and lead to weight loss, low blood pressure, characteristic tanning of the skin, poor circulation, low blood sugar level, depression and reduced resistance against infection. In Addison’s disease, skin hyperpigmentation is very common especially in the hands, knees and mucous membrane. Increased craving for salts is another common symptom for Addison’s disease because of the increased loss of sodium in the urine.
Diagnosis
Because of the slow progression of adrenal insufficiency, many cases are left undiagnosed for long periods of time. But in the latter part of the disorder, doctors suspecting for the problem use the long medical history and physical examination in the diagnosis. Laboratory tests also aid in the confirmation of the reduced cortisol level. The most common is the ACTH stimulation test. Doctors inject an artificial form of ACTH. In normal individuals, the cortisol level rises in the urine. But in patients with adrenal insufficiency, the adrenal glands do not respond to the stimulation and thus, the cortisol level remains low. Other results to accompany the diagnosis include low sodium level, high potassium level, low blood glucose and increased blood urea nitrogen (BUN).
After knowing the presence of adrenal insufficiency, the next goal is to determine the exact cause of the illness. X-ray, CT scan and MRI procedures are just some of the ways to visualize the endocrine organ involved.
Treatment
Drugs
The treatment for the illness is hormone replacement therapy. Doctors prescribe drugs to replace the involved hormone. For cortisol, they prescribe patients to take hydrocortisone tablets and for aldosterone, oral doses of mineralocorticoids are given. Your doctor determines the dose of drug to take. Aside from the hormone replacement, other medications are also needed to address the symptoms like low blood sugar and hypotension.
Surgery
In some cases, surgery may be required to permanently address the problem. The surgery removes the tumor in the pituitary gland. Because of the risk of the procedure, this is actually the last option of doctors.
Home Remedies
To facilitate a more successful treatment, doctors prescribe diet modifications. They encourage an increase salt intake to replace the lost salt in the urine. You must also increase your intake of vitamins and minerals to boost the functions of the immune system. Citrus fruits, green leafy vegetables and fruit juices help improve your condition. Because you have fewer defenses against stress, you must learn on the proper ways to reduce your inner pressure. Relaxation techniques and meditation exercises are very helpful in managing the symptoms of adrenal insufficiency.
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