Adrenal insufficiency refers to a condition in which the adrenal glands do not produce enough steroid hormones. The adrenal glands are situated above the kidneys. They secrete hormones that are essential for body functions including control of blood pressure and sugar levels, blood volume and sodium or salt levels in the bloodstream. The adrenal glands secrete three types of steroid hormones; cortisol, aldosterone and androgens. These hormones are released during physical stress. Adrenal insufficiency leads to reduced production of any of the three hormones, especially cortisol during physical stress.
There are two types of adrenal insufficiency:
- Primary adrenal insufficiency: In this condition, the cortex or outer layer of adrenal glands that produce the steroid hormones get damaged and do not produce enough stress hormones; especially the cortisol. Aldosterone can also be produced in lesser amounts.
- Secondary adrenal insufficiency: In this condition, the master gland (pituitary) does not stimulate the adrenal glands to produce enough cortisol. The pituitary gland produces a hormone known as the adrenocorticotropic hormone (ACTH) which in turn stimulates the adrenal cortex to produce its hormones. Any inflammations, tumours or other damages to the pituitary gland can affect the adrenal glands.
Causes of primary adrenal insufficiency includes:
- Autoimmune disease
- Genetic disorder
- Infections in glands
- Surgical removal of adrenal glands
- Bleeding in the adrenal glands
Causes of secondary adrenal insufficiency includes:
- Pituitary gland disorders
- Certain medications
- Radiation exposure
Symptoms of adrenal insufficiency usually appear and progress slowly.
- Muscle weakness
- Loss of appetite
- Weight loss
- Abdominal pain
- Nausea and vomiting
- Joint and muscle pains
- Excessive sweating
- Low blood sugar levels
- Darkening of skin
- Increased salt cravings
- Irregular menstrual cycles
- Body hair loss in women
- Review of signs and symptoms
- Medical history
- Blood tests
- ACTH stimulation test
- Insulin induced hypoglycemia test
- Imaging procedures such as CT and MRI
Adrenal insufficiency cannot be prevented. Certain steps can be taken to reduce worsening of the condition and further damage.
- Awareness and proper patient education regarding the condition is necessary.
- Early identification and proper treatment especially when physical stress occurs.
- Always have an emergency management plan as per your doctor’s suggestions.
- Watch out for conditions like fever and diarrhoea, which can lead to further complications and get immediately treated.
Adrenal insufficiency is an uncommon disorder, which is often left unrecognised and may lead to serious health conditions and can be deadly if not treated at early stages.
The treatment for adrenal insufficiency focuses on maintaining proper hormone levels.
- Hormone replacement is the procedure used in the treatment which involves using medicines to replace the hormones which the body doesn’t produce enough. The dosage of the medicines varies depending on the patient’s health factors and other conditions including pregnancy, surgery or injuries.
- High salt diet or high sodium diet is also recommended for adrenal insufficiency.
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