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 Adrenal
insufficiency is a deficiency of hormones produced by the adrenal
glands. Addison's disease is a term reserved for adrenal insufficiency
due to destruction of the adrenal glands. It may occur at any age,
and affects both sexes equally.
How
does it occur?
The
adrenal glands are important in producing several hormones essential
to body metabolism and fluid regulation. The production of these
hormones is under the control of hormones produced by the brain.
With this in mind, one can see how insults to either the brain or
adrenal gland itself could lead to underproduction of adrenal hormones.
Direct
injury to the brain or adrenal glands, whether by infection, trauma,
or bleeding can lead to adrenal insufficiency and Addison's disease.
Also, cancer of the adrenal glands may affect the ability of the
gland to produce hormones.
More
commonly, adrenal insufficiency results from the secondary use of
steroid hormones followed by withdrawal. When steroids are taken
for a long time, they suppress the body's own adrenal glands from
producing hormones. Over time, the adrenal glands literally "shut
down" as the exogenous source of steroid hormones (e.g., the prescribed
medication) circumvent the need for the body to produce hormones
on its own.
When
steroid medications are stopped, the adrenal glands remain in a
"shut down" state and need anywhere from a few weeks to
months to adequately produce the levels of hormones that the body
needs. This is why only doctors should guide patients in how to
slowly come off of their steroid medications.
Note
that in this scenario, the adrenal glands themselves are not destroyed,
but rather "shut down." Patients who fall into this scenario
are unlikely to develop Addison's disease.
What
are the symptoms?
Patients
will commonly complain of fatigue, weakness, anorexia, nausea, and
vomiting. Low blood pressure as well as central nervous system signs
of confusion or even coma may present. Other signs can include hyperpigmentation
of the skin, cyanosis, and sparse hair in the armpits.
How
is it diagnosed?
After
asking questions and performing a physical exam, the doctor will
order blood tests if he suspects adrenal insufficiency. The most
common test involves stimulating the adrenal glands with an injected
synthetic hormone and then checking blood levels within an hour
for the levels of adrenal hormones. The measured levels will be
low in people with adrenal insufficiency.
The
doctor may also order additional blood work to check for abnormalities
in various minerals, blood cell counts, and certain hormone levels.
If
infection is suspected, blood cultures may be obtained. A (computed
tomography) CT scan may also be done if a tumor or bleeding is suspected.
How
is it treated?
Fortunately,
oral medications exist that can adequately treat adrenal insufficiency.
Hydrocortisone and fludrocortisone are two medications that adequately
replace the hormones underproduced by the adrenal glands. Both medicines
are taken by mouth daily. Optimal dosage of the medication is based
upon a combination of symptoms, physical findings on examination,
and blood work.
Complications
of treatment are largely from difficulty in dosing of medications.
Blood pressure changes and heart problems can occur.
If
you have Addison's disease, you should be instructed in the self-administration
of injectable steroid hormones, as well as the signs and symptoms
to watch for if complications develop.
It
is also essential that you carry a medical ID card, such as your
PersonalMD.com ER card stating that you have the disease, as certain
treatments or medications may be indicated in an emergency. Your
PersonalMD.com ER card will also give emergency room doctors access
to important medical record information, such as the type and dosage
of the medications you are taking.
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