Adrenal insufficiency

Adrenal insufficiency is a condition in which the adrenal glands, located above the kidneys, do not produce adequate amounts of steroid hormones (chemicals produced by the body that regulate the function of other organs), primarily cortisol, but may also include impaired aldosterone production (a mineralcorticoid) which regulates sodium, potassium and water retention.

Addison's disease is the worst degree of adrenal insufficiency, which if not treated, severe abdominal pains, profound weakness, extremely low blood pressure, kidney failure, and shock may occur (adrenal crisis). An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, or severe infection. Death may quickly follow.

Adrenal insufficiency can also occur when the hypothalamus or the pituitary gland, both located at the base of the skull cavity, doen't make adequate amounts of the hormones that assist in regulating adrenal function. This is called secondary adrenal insufficiency and is caused by lack of production of ACTH in the pituitary or lack of CRH in the hypothalamus.

Types of Adrenal Insufficiency

 * Adrenal impairment (primary adrenal insufficiency)
 * Addison's disease (autoimmune adrenalitis)
 * Congenital adrenal hyperplasia


 * pituitary or hypothalamus impairment (secondary adrenal insufficiency)
 * pituitary micro adenoma
 * pituitary macro adenoma
 * head injury
 * Sheehan's syndrome (associated only with pituitary impairment)
 * environmental
 * genetics

Causes

 * Autoimmunue (may be part of a polyglandular autoimmune disorder which can include type I Diabetes Mellitus, autoimmune thyroid disease (also known as autoimmune thyroiditis, Hashimoto's thyroiditis and Hashimoto's disease)
 * Discontinuing corticosteroid therapy without tapering the dosage (severe adrenal suppression with ACTH suppression)
 * Surgery, illness or any other forms of stress
 * Injury

Method of diagnosis and treatment

 * Assessment of symptoms
 * The person may show symptoms of dehydration, weightloss and disorientation. They may experiance weakness, tiredness, dizziness, Low blood pressure that falls further when standing (orthostatic hypotension), muscle aches, nausea, vomiting, and diarrhea.  These problems may develop gradually and insidiously.  Addison's can present with tanning of the skin which may be patchy or even all over the body and so dark that a person with light skin can look like they are from a another country.  Characteristic sites are skin creases (e.g. of the hands) and the inside of the cheek (buccal mucosa)j.  goitre and vitiligo may also be present.


 * Testing
 * If the person is in adrenal crisis, the ACTH stimulation test may be given. If not in crisis, cortisol, ACTH, aldosterone, renin, potassium and sodium are tested from a blood sample before the decision is made if the ACTH stimulation test needs to be performed.  X-rays or CT of the adrenals may also be done.


 * Treatments
 * Adrenal crisis
 * Intravenous fluids
 * Intravenous steroid (Solu-Cortef of Solumedrol), later hydrocortisone, prednisone or methylpredisone tablets
 * rest


 * Cortisol deficiency (primary and secondary)
 * Adrenal cortical extract (usually in the form of a supplement, non prescription)
 * Hydrocortisone (Cortef) (between 20 and 35 mg)
 * Prednisone (Deltasone) (7 1/2 mg)
 * Prednisolone (Delta-Cortef) (7 1/2 mg)
 * Methylprednisolone (Medrol) (6 mg)
 * Dexamethasone (Decadron) (1/4 mg, some doctors prescribe 1/2 to 1 mg, but those doses tend to cause side effects resembling Cushing's disease)


 * Mineralcorticoid deficiency (low aldosterone)
 * Fludrocortisone (Florinef) (To balance sodium, potassium and increase water retention)