People with adrenal insufficiency develop acute low cortisol levels in their blood. The adrenal glands produce cortisol, a hormone that the body uses to respond to stress and maintain normal functioning of several systems and processes in the body. Cortisol helps maintain proper functioning of the cardiovascular system, the immune system and the metabolism of fats, carbohydrates and proteins. Doctors treat acute low cortisol levels with the replacement of one or more hormones.
Patients with adrenal insufficiency can have primary or secondary adrenal insufficiency. Primary adrenal insufficiency, or Addison’s disease, develops when the adrenal glands are damaged and cannot produce the levels of cortisol or another hormone called aldosterone that the body requires. Secondary adrenal insufficiency is a condition that causes the pituitary gland to produce low amounts of adrenocorticotropin, a hormone that stimulates the body’s adrenal glands and increases cortisol production. Addison’s disease is less common than secondary adrenal insufficiency.
Hormone Replacement Treatment
Doctors treat adrenal insufficiency with hormone replacement treatment. Acute low cortisol levels are supplemented with an oral glucocorticoid medication such as dexamethasone, prednisone or hydrocortisone. Patients with Addison’s disease may require an oral mineralocorticoid medicine such as fludrocortisone acetate to supplement low levels of aldosterone. Physicians prescribe doses of these hormones according to the level of hormone deficiency of each individual patient. A doctor may adjust the dosage of a hormone replacement medication if a patient’s hormone levels change.
Adrenal Insufficiency Symptoms
Patients with acute low cortisol levels commonly develop chronic fatigue that gets progressively worse, unexplained weight loss and muscle weakness. People may start to crave salty foods due to a loss of salt. Low blood sugar, depression and irritability have been reported with this disorder. People with low cortisol levels may have headaches, sweating or changes in menstrual periods. An abnormal skin darkening called hyperpigmentation can develop with Addison’s disease but does not occur with secondary adrenal insufficiency.
An Addisonian crisis, or adrenal crisis, is a sudden and severe drop in cortisol levels that can be fatal if not treated. This problem causes penetrating pain in the legs, abdomen or lower back, as well as dehydration and low blood pressure. People may develop severe diarrhoea, vomiting and a loss of consciousness during an Addisonian crisis. Doctors treat Addisonian crisis patients with intravenous glucocorticoids and intravenous saline fluids with dextrose. Glucocorticoid dosage is reduced as the patient’s condition improves.
Adrenal Insufficiency Causes
Causes of adrenal insufficiency include damage to the adrenal glands from an autoimmune disease that attacks the glands, tumours that harm the adrenals or a loss of blood. Fungal infections, tuberculosis and other infections can also cause damage to the adrenal glands and reduce cortisol production. Patients who use blood-thinning drugs have an increased chance of developing adrenal insufficiency. People with chronic thyroiditis, Grave’s disease and pernicious anaemia have an increased risk of getting Addison’s disease.