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Adrenocortical Insufficiency

What is adrenal insufficiency (hypocorticism)?

Adrenocortical insufficiency - a syndrome, all of whose manifestations are due to insufficient allocation of adrenal hormones in the blood.

The causes of adrenal cortex

Adrenocortical insufficiency is acute and chronic. Chronic adrenocortical insufficiency may be primary or secondary.

Primary adrenocortical insufficiency (Addison's disease) is the result of tissue destruction of the adrenal gland. Primary adrenal insufficiency develops, if maintained and operated at least 10-15% of adrenal tissue.
By the predisposing factors of primary adrenal insufficiency include:

-infectious diseases (syphilis, tuberculosis, fungal diseases of adrenal glands),
-adrenal amyloidosis,
-HIV infection,
-idiopathic atrophy of the adrenal cortex (an autoimmune process, with the body of as yet unknown reason the immune system is impaired control, and the formation of autoantibodies that destroy the cell's own adrenal glands).

Secondary adrenocortical insufficiency occurs in diseases of the brain with a lesion of the pituitary or hypothalamus (a brain tumor, traumatic brain injury, after brain surgery after radiotherapy, at various intoxications), which normally control the activity of the adrenal glands.

Acute adrenal insufficiency, or addisonian crisis - acute coma.

Acute adrenocortical insufficiency may develop:

- the background of already existing chronic deficiency of adrenal hormones;
- the surgical removal of the adrenal glands on the disease Cushing's syndrome (Nelson);
- In sharp cancellation of glucocorticoids assigned to treatment.

The cause of acute adrenal insufficiency may be an autoimmune thyroiditis (Schmidt's syndrome).

Acute adrenocortical insufficiency may occur in the newborn due to hemorrhage in the adrenal glands during heavy and prolonged labor due to birth trauma or exposure to various infections. Such a condition called Syndrome Waterhouse-Friderichsen. In adults and older people bleeding in the adrenal glands can occur against a background of trauma abdomen and chest, with an overdose of anticoagulants in surgical interventions, sepsis, peritonitis, burns.

In case of insufficiency of the adrenal cortex decreases sharply blood levels of hormones glucocorticoids and mineralocorticoids. At the same time the body loses its ability to adapt to stressful situations.

Features characteristic of adrenal insufficiency

Primary adrenal insufficiency (Addison's disease) - is relatively rare, occur at any age and members of both sexes.

Primary adrenal insufficiency usually begin gradually. In the beginning there are complaints of weakness, fatigue, especially in the evening. Sometimes this weakness occurs only after exercise or stressful situations. Deteriorating appetite, patients often suffer from colds. There is poor tolerance of solar radiation, accompanied by a persistent tan.

In the course of Addison's disease muscle weakness becomes more pronounced. The patient is difficult to make any movement. Even his voice is quiet. Reduced body weight. Almost all patients appear resistant hyperpigmentation (increased skin coloration), especially in areas of friction of clothing, in open areas of the body exposed to sunburn, increases paint nipples, lips and cheeks. There is a persistent decrease in blood pressure, increased heart rate. There are disorders of the gastrointestinal tract: nausea, vomiting, constipation, diarrhea alternated. Reduced the number of glucose in the blood. Disrupted the kidneys, often manifested by nocturnal urination. The central nervous system disorders arise in attention, memory, depression. In women, due to lack of androgens fall pubic hair and armpits.

In patients with secondary adrenal insufficiency observed most of the same signs and symptoms in patients with Addison's disease, but they are characterized by the absence of hyperpigmentation.

For addisonian crisis characterized: cardiovascular collapse, falling blood pressure, gastrointestinal disturbances (uncontrollable vomiting, loose stools multiple), neuro-psychiatric disorders.

Forecast

Prognosis in patients with Addison's disease depends largely on the prevention and treatment of Addison's crises. In the case of infection, trauma, including surgery, gastro-intestinal disorders, or other types of stress, you should immediately increase the dose received by the hormone. Treatment should be directed to the rapid increase in the level of glucocorticoids in the blood and deficiency of sodium and water.

What can your doctor?

Diagnosis of early stages of adrenal insufficiency is often difficult. However, lung disorders of the gastrointestinal tract with a decrease in body weight, appetite loss, and suspected enhanced pigmentation justify the holding of special provocative tests to rule out adrenal insufficiency, especially before the start of hormone replacement therapy. All patients with Addison's disease should receive specific substitution therapy with hormones: glucocorticoids and mineralocorticoids.

In the treatment of patients with Addison's disease should be periodically record the weight, the level of serum potassium and blood pressure.

Replacement glucocorticoid therapy in patients with secondary adrenal insufficiency do not differ from that in patients with Addison's disease. In mineralocorticoid replacement therapy is usually not necessary. In all other treatment of patients with secondary adrenal insufficiency based on the same principles.
Adequate replacement therapy corticosteroid hormones under constant review the most effective methods of prevention addisonian crisis.

What can you do?

When the above symptoms should seek immediate medical attention. If untreated the disease at any time may addisonian crisis, which is difficult to treat and can lead to death.