Adrenal Insufficiency

Hormones are the organic substance secreted by the endocrine system and function as a body’s chemical messengers by carrying messages between cells and organs. These hormones also affect our body’s functions, metabolism, growth and other developments. These chemical substances are secreted by glands of the endocrine system. Adrenal glands also called the suprarenal glands of the endocrine system. They are found above the kidneys and functions by producing a variety of hormones including adrenaline, androgens, steroids aldosterone and cortisol. In certain conditions, the body produces too much or too little of a particular hormone, which results in serious and life-altering disorders.

Also read: Endocrine Glands

What is Adrenal Insufficiency?

Adrenal insufficiency is a hormonal disorder caused by the failure of the adrenal glands to produce sufficient amounts of cortisol and aldosterone hormones. Prolonged lack of cortisol leads to severe fatigue, chronic exhaustion, depression, loss of appetite and weight loss. It is an often elusive diagnosis that requires awareness, knowledge of symptoms and signs and endocrinological expertise to be correctly diagnosed and adequately treated. Lack of the steroidal hormone leads to a drop in blood pressure. Sometimes patients with disturbed salt levels in the blood also, describe a craving for salty food. Loss of DHEA production by the adrenals results in low energy levels,  reduced sex drive, loss of hair in pubic and underarm areas.

Adrenal insufficiency is a rare endocrine or hormonal disorder that affects about 2 or 3  individuals in millions. It occurs in all age groups and sex equally.

Causes of Adrenal Insufficiency

Adrenal insufficiency, or Addison disease, has many causes, the most common of which are autoimmune adrenalitis.

Autoimmune adrenalitis results from the destruction of the adrenal cortex, which leads to deficiencies in glucocorticoids, mineralocorticoids, and adrenal androgens. Adrenal insufficiency can be described as primary, secondary or tertiary depending on the causes of the condition.

Primary adrenal insufficiency or Addison’s disease occurs when the adrenal cortex has been destroyed. There are different causes for primary adrenal insufficiency, but 70–90 per cent of cases are due to an autoimmune disorder and caused when the body’s own immune system attacks the outer layer (cortex) of the adrenal glands, the exact fact behind this is unaware.

Symptoms of Adrenal Insufficiency

Addison’s disease symptoms usually develop slowly and may also take several months to develop the symptoms. The common signs and symptoms include :

• Lethargy
• Dehydration
• Weight loss
• Depression
• Painful joints
• Abdominal pain
• Extreme fatigue
• Muscle weakness
• Decreased Appetite
• Low blood pressure
• Discolouration of the skin
• Irritability or Mood swings
• More cravings for salty foods
• Low blood sugar – hypoglycemia
• Nausea, diarrhoea and other gastrointestinal symptoms

Diagnosis of Adrenal Insufficiency

It will be challenging to diagnose adrenal insufficiency in its early stages. Based on the patient’s medical history and other signs and symptoms, doctors may prescribe the patients to undergo certain physical and biochemical laboratory tests to detect the presence of Addison’s disease.

Some physical test includes:

• Examine the skin for discolouration
• Review the patient’s medical records and inquire about a family history of other autoimmune conditions
• Observe the patient’s blood pressure from a sitting and standing position to see if they are suffering from postural hypotension.

Biochemical laboratory tests:

• A blood test to measure the sodium, potassium and other  hormonal levels in the blood
• ACTH stimulation tests to measures the level of cortisol in the blood
• Insulin-induced hypoglycemia test – this is to test the glucose and cortisol levels in the blood.

Other than the physical and blood test, few Imaging tests are carried on like:

• MRI scans of the pituitary gland
• CT or computerized tomography scans for the abdomen region to check the size of the patient’s adrenal glands.

Treatment for Adrenal Insufficiency

The first and primary treatment for Addison’s disease involves medication. As it is a hormonal disorder, patients are given hormone replacement therapy to balance the levels of steroid hormones in their body. Therefore, they need to take medicines on a daily basis.

Once diagnosed with adrenal insufficiency, most patients will need to take medicines on a daily basis. This is because most cases could not be cured; therefore, the condition needs to be managed, and continuous treatment is required. Other treatments include:

Intravenous injections of Corticosteroids and other mineral deficiency.

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