Adrenal insufficiency

At a Adrenal insufficiency the adrenal cortex can no longer produce enough hormones. A distinction must be made between primary and secondary adrenal insufficiency according to localization.

What is adrenal insufficiency?

Schematic representation of the anatomy and structure of the adrenal gland. Click to enlarge.

About 5 in 100,000 people have this rare disease. A primary Adrenal insufficiency is also known as Addison's disease designated. When the adrenal cortex can no longer work properly, it can lead to a life-threatening situation.

The adrenal gland is made up of the adrenal cortex, which makes cortisol, aldosterone, and sex hormones, and the adrenal medulla, which produces adrenaline and noradrenaline. The hormone ACTH, which is produced in the anterior pituitary gland of the pituitary gland, controls the production of cortisol. When blood cortisol levels drop, more ACTH is released, which increases production in the adrenal gland.

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But aldosterone, which is responsible for regulating the concentration of potassium and sodium, is also formed in the adrenal cortex. In contrast to cortisol, the production of this hormone is not regulated by the pituitary gland, but by the RAAS.

causes

The causes of one Adrenal insufficiency getting sick can be different. First of all, it has to be diagnosed whether it is primary or secondary adrenal insufficiency. This gives information about the localization of the cause of the disease.

In the primary form, the central nervous system can no longer produce any of the hormones it needs. So she is sick herself. In the secondary form, the hypothalamus is diseased, which also means that no hormones can be produced.

This is simply due to the fact that the hypothalamus no longer sends CRH to the pituitary gland, which in turn no longer sends ACTH to the adrenal cortex. ACTH stimulates the production of cortisol. The production of aldosterone is only slightly affected.

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Symptoms, ailments & signs

Symptoms of adrenal insufficiency usually only appear after 90 percent of the adrenal cortex has been destroyed. A distinction is made between general symptoms and specific symptoms. The latter are due to a lack of the hormones cortisol and / or aldosterone. The general symptoms include nausea and vomiting, loss of appetite, weight loss, fatigue, significantly reduced performance and unspecific gastrointestinal complaints.

A lack of cortisol also leads to fluid loss, which brings the risk of acute kidney failure. In addition, there is hyperacidity of the blood, low blood pressure (mostly systolic <100 mm Hg), dizziness, and reduced sodium levels and increased potassium levels in the blood, the latter being associated with an increased risk of cardiac arrhythmias.

A cortisol deficiency can also lead to hypoglycaemia, which usually manifests itself in the form of anxiety, sweats and palpitations. In addition, mental disorders, brown skin pigmentation (hyperpigmentation) and the breakdown of fat and muscle mass can occur.

Additional stress, such as operations or illness, can lead to a sudden worsening of adrenal insufficiency. In particular, if this is not treated, it leads to a potentially fatal condition, which is characterized by impaired consciousness up to coma, drop in blood pressure, fever, dehydration, and hypoglycaemia.

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Diagnosis & course

To a Adrenal insufficiency To be able to determine this, some tests are necessary. In addition to a blood count, urine must be collected for 24 hours and a daily cortisol profile set up.

In addition, it is possible that an ACTH test could be arranged. Since cortisol copes with stress, people are particularly at risk in stressful situations. The disease can even lead to Addison's crisis, which can be fatal. For this reason, a patient must always carry an emergency ID card and cortisone with them.

The Addison crisis is an extreme drop in cortisol levels. This will initially manifest itself through weakness, restlessness and fears. But extreme freezing, diarrhea, and vomiting will also appear without treatment. In this sense, however, the term stress includes physical exertion such as operations, accidents and infectious diseases.

Complications

In the worst case, adrenal insufficiency can lead to death of the person concerned. For this reason, this disease must be treated in any case, since self-healing usually does not occur. Those affected suffer from adrenal insufficiency primarily from a general weakness. Furthermore, they lose weight for no particular reason and also suffer from a high susceptibility to infections.

This means that various infections or inflammations occur more often and more easily. As a rule, this disease also leads to severe abdominal pain, vomiting and also nausea. The patients suffer from severe hunger, with foods containing salt being preferred. Dizziness or pallor can also occur in adrenal insufficiency and significantly reduce the patient's quality of life.

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It can also lead to hypoglycaemia and a loss of consciousness in the patient. Treatment of adrenal insufficiency is carried out with the help of drugs. There are no particular complications. However, the patient's thyroid gland must also be examined, as this can also be affected by a malfunction. With successful and correct treatment, the life expectancy of the person affected is not reduced.

When should you go to the doctor?

Adrenal insufficiency usually only becomes noticeable when large parts of the kidney have already been destroyed. Therefore, the cause should be treated as early as possible. People who suffer from alcoholism or diabetes are among the risk patients and must be treated closely to prevent adrenal insufficiency in the first place. At the latest, when signs such as persistent tiredness, nausea and vomiting as well as loss of appetite are noticed, you must go to a doctor with the condition. Nonspecific complaints in the gastrointestinal area also require rapid clarification.

If you suffer from dizziness, cardiac arrhythmias, or weakness, you may be severely dehydrated, which requires medical treatment. Anxiety and other psychological complaints also indicate a lack of nutrients. Affected people are best to speak to their family doctor, who can diagnose the condition or call in a specialist. Adrenal insufficiency is treated by a nephrologist or other internist. Any psychological complaints that may arise in connection with the disease must be treated therapeutically.

Treatment & Therapy

Once the problem of the Adrenal insufficiency is recognized and the therapy is carried out, there will most likely be no major incidents if taken properly.

Cortisol should usually be taken twice a day.However, since some patients experience problems at night, it can be taken several times a day. It is particularly worth knowing that the drugs have a long-term effect, which means that high doses are strictly prohibited.

In addition, preparations are offered that break down quickly. This includes, for example, hydrocortisone, which is increasingly used in the Addison crisis or in emergencies. This can be administered in high doses. Furthermore, adrenal insufficiency patients should not exert themselves too much in everyday life. You should give your body enough sleep every day.

If there is an infection, a doctor should be consulted immediately, as the cortisol dose must be increased. After the illness, however, the drug can be slowly reduced again. If it is a secondary hypothyroidism, thyroid hormones must often be taken as well. Adrenal insufficiency is not curable, but can be treated well, which means that quality of life can be maintained.

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➔ Medicines against fatigue and weakness

Outlook & forecast

Adrenal insufficiency (also known as Addison's disease) is an incurable disease, because if damage to the adrenal cortex occurs, it cannot be reversed. However, if a chronic, slowly progressing adrenal insufficiency is detected early enough, treatment with vital hormones is possible.

This hormone replacement must be taken for a lifetime, but patients can then lead an almost normal life and have an average life expectancy if the prescribed medication is taken regularly. In the case of adrenal insufficiency, pregnancy is very often possible if those affected have their hormone levels checked regularly or if these are well adjusted.

Problems can arise when the concentration of hormones does not correspond to the prevailing stress level of the patient. If adrenal insufficiency is not treated, the disease is always fatal. There is also a mortal danger in the case of an acute Addison's crisis, especially if this occurs together with the so-called Waterhouse-Friderichsen syndrome. The chances of an almost symptom-free life are therefore enormously increased by acting in good time. Therefore, the first symptoms and alarm signs should definitely be taken seriously by those affected.

prevention

To the Adrenal insufficiency Unfortunately, there are no concrete and proven measures to prevent this, but you should nonetheless stick to a few rules. Once you have fallen ill, you should have ID and emergency medication with you. This way you always have the situation under control.

Most of the time, stress should be avoided. Before operations and during infections, the cortisol dose must be increased to avoid an Addison crisis. A healthy lifestyle will avoid diseases that are known to be possible causes of primary and secondary forms of Addison's disease.

Aftercare

In most cases of adrenal insufficiency, those affected have very few and often only very limited direct follow-up measures available. Those affected should first and foremost consult a doctor very early in order to prevent and limit the occurrence of other complications and complaints. In the case of adrenal insufficiency, there is usually no independent healing, so that a doctor should be consulted at the first signs of the disease.

As a rule, those affected with adrenal insufficiency are dependent on the intake of various medications. Those affected should follow the doctor's instructions and ensure regular intake and correct dosage.

In the case of the disease, regular monitoring by a doctor is often very important. Furthermore, the affected person should rest and take it easy, but refrain from strenuous exertion or physical activity. The help and care of one's own family also has a positive effect on the further course of the disease and can sometimes prevent the development of mental disorders.

You can do that yourself

Adrenal insufficiency is a hormonal disorder. In addition to therapy with cortisone, those affected can take a number of measures to increase their well-being. Those affected often feel exhausted. It is therefore advisable to structure the day well. Too many appointments in one day or too many sports or household activities can lead to excessive demands.

Since Addison patients often have hypoglycaemia, several small meals at intervals of approx. 3-4 hours are recommended. This keeps blood sugar stable for longer. A banana or a slice of bread in between can be enough. Whole grain products are well suited for the stability of blood sugar. In order to be able to prevent hypoglycaemia on the go, it makes sense to have glucose, a sweet drink such as apple juice or a banana with you in your handbag or backpack. This means that dangerous hypoglycaemia cannot occur during longer walks or meetings. The bag also includes cortisone tablets and an emergency ID.

Listening to the signs of the body is also important. If you feel exhausted, it is advisable to take a break, even if others do not understand it. Addison patients do better when they listen to signals from their bodies and learn to say no.