Adrenal Insufficiency

What is it?
Adrenal insufficiency is a life-threatening condition caused by the disrupted functioning of the adrenal gland called the cortex. The condition causes decreased production of two important hormones normally released by the cortex, cortisol and aldosterone. Infection or hemorrhaging of the gland often results, and all functions of the gland are lost.
Who gets it?
Adrenal insufficiency occurs in about four in every 100,000 people. The condition can strike both men and women of all ages, but is more common in middle-aged women.
What causes it?
The shrinking or destruction of the adrenal cortex from an autoimmune disorder is the most common cause of adrenal insufficiency. In a person with an autoimmune disorder, the body accidentally identifies the cells of the adrenal cortex as foreign, destroying them. Other causes of the shrinking or destruction of the adrenal cortex are tuberculosis, fungal infection, a disease called amyloidosis, or cancer.
What are the symptoms?
Patients diagnosed with adrenal insufficiency typically experience fatigue and loss of energy, loss of appetite, nausea, vomiting, diarrhea, abdominal pain, weight loss, muscle weakness, dizziness when standing, dehydration, anxiety and depression. The patient may also notice increased bronze pigmentation of the skin and mucous membranes and decreased tolerance to cold. Women lose pubic and underarm hair and stop having normal menstrual periods. Unfortunately, significant symptoms are usually not noticed until about 90% of the adrenal cortex has been destroyed.
How is it diagnosed?
Many people do not recognize the slow progression of symptoms of adrenal insufficiency and it is ultimately identified when a doctor notices the areas of increased pigmentation of the skin. A doctor will run laboratory blood tests to reveal abnormally low blood concentrations of sodium and glucose, a greater than normal level of serum potassium, and a decreased urinary output of certain steroids. The doctor will diagnosis adrenal insufficiency if the amount of cortisol in the plasma and steroid in the urine does not increase after the patient takes a synthetic steroid.
What is the treatment?
Treatment of adrenal insufficiency includes replacing missing or low levels of cortisol with synthetic steroids such as glucocorticoid, adrenal genital corticoids, and mineralocorticoid drugs. Patients with adrenal insufficiency will need to take a steroid by mouth for the rest of their lives. Resulting dehydration and salt loss should be treated with an adequate fluid intake and a diet high in complex carbohydrate and protein. Dangerously low blood pressure may require special medications to safely elevate it until the steroids take effect. Follow-up care includes frequent monitoring of blood sugar and urinary acetone levels and continued administration of the steroids.
Self-care tips
Early diagnosis and treatment for patients diagnosed with adrenal insufficiency will usually be life-saving. However, patients need to be aware of the significance of emotional distress, the value of wearing a medical-alert bracelet or tag, the signs of impending crisis, the use of a prepared kit for emergencies, and the importance of careful attention to drug use and diet. In addition, steroid replacements should only be taken after meals or with milk to prevent gastric irritation and the development of ulcers. Most patients following treatment can expect to enjoy a fully active life and normal lifespan