Adrenal insufficiency is a serious disorder of the endocrine system, characterized by a decrease in the production of hormones in the adrenal cortex. The disease is characterized by a severe and constantly progressive course. It occurs almost equally in both sexes. Often diagnosed in middle age, from twenty to forty years. In medicine, this state has a second name — hypocorticism.

There are several forms of hypocorticism — the primary forms against the background of disruption of the adrenal glands. Secondary arises because of improper functioning of the hypothalamus and pituitary gland. In any case, there is a decrease in the level of adrenocorticotropic hormone or ACTH.

In addition, adrenal insufficiency can occur in acute or chronic form. In the second case, the disease proceeds without expressing any signs. Such a symptom, as an excessive predilection for salty foods, often does not cause alertness in people. That is why for a long time the disease is not recognized and not treated. The acute form of the disorder manifests itself much brighter. There is a sharp drop in blood pressure, dyspnea, convulsions, loss of consciousness, vomiting and diarrhea. The most characteristic sign is the discoloration of the skin and mucous membranes — they acquire a bronze shade.

Diagnosis of hypocorticism is to identify the main factors of the onset of the disease, the examination of the patient, laboratory tests of blood tests. In addition, an instrumental examination is carried out, which includes ultrasound, CT and MRI. In some cases, you may need additional advice from a geneticist. Treatment of the disease is aimed at eliminating predisposing factors and underlying symptoms, and also provides for substitution treatment with corticosteroid medications.

Etiology

Depending on the type of adrenal insufficiency, there are several reasons for the progression of such a disease. Primary deficiency is formed when the adrenal glands work improperly, which can be caused by such factors as:

  • autoimmune diseases, in which the body attacks its own tissues. This is the cause of almost all cases of hypocorticism. The appearance of this condition is not fully understood, but it is often accompanied by lesions of the endocrine system
  • congenital anomalies of adrenal cortex development
  • Tuberculosis
  • protein deposition
  • genetic diseases
  • metastasis of the oncology or its focus in this organ
  • bleeding in the adrenal glands — often caused by viral infections
  • Oxygen deficiency in childbirth — causes the expression of such an ailment in newborn babies
  • HIV infection
  • removal of the adrenal glands
  • use for a long time of drugs that are directed at suppressing the work of the adrenal cortex or their toxic damage.

Secondary hypokorticism is expressed in the following pathologies of the pituitary:

  1.  bleeding due to injuries
  2.  viral infections
  3.  cancerous tumors
  4.  organ irradiation
  5.  Complications after surgery
  6.  congenital anomalies
  7.  attack the pituitary with its own antibodies.

Congenital and acquired pathologies of the hypothalamus form a tertiary adrenal insufficiency. In infants up to the age of three, even the most insignificant factors can cause an ailment. For example, ARVI and stress, vaccinations or intestinal infections. In addition, in newborns, hypokorticism often develops if the baby was born at the time of birth (the causes of this phenomenon have not yet been clarified).

Species

According to the intensity of manifestations of hypokorticism, there are two forms of the disease:

  • acute adrenal insufficiency, in which there is rapid destruction of the cortex. This can be caused by bleeding, trauma or surgery. Because of the vivid expression of signs and rapid development, this condition is considered deadly, requiring immediate treatment;
  • chronic adrenal insufficiency. The main cause of occurrence is autoimmune lesions. With timely diagnosis and proper therapy, the disease can be controlled for a long time.

Depending on the localization of the pathogenic process, hypocorticism is divided into:

  1.  primary failure — the organ itself and the adrenal cortex are affected;
  2.  secondary adrenal insufficiency — associated with pituitary diseases
  3.  tertiary, in which the center of the ailment is the hypothalamus.

Primary insufficiency of the adrenal cortex differs by a more severe course than the remaining two forms.

Symptoms

Signs of this disorder will differ with the rate of destruction of adrenal tissue. If they die a large number, then develops an acute adrenal insufficiency, which has its own characteristic symptoms. In cases where the process of tissue disintegration is expressed gradually, chronic hypocorticism progresses, which is expressed in completely different signs.

Symptoms of adrenal insufficiency with chronic course:https://web.archive.org/web/20180702035905if_/https://www.youtube.com/embed/EhMdChazw6Q

  • The acquisition of a bronze or brown hue by the skin and mucous membranes. The intensity of color directly depends on the duration of the disease. Such a symptom is characteristic only of the primary type of disease;
  • loss of a large amount of body weight — from three to fifteen kilograms
  • nausea and vomiting
  • diarrhea followed by constipation
  • soreness in the abdomen
  • increased irritability;
  • lethargy and depression
  • muscle weakness;
  • decrease in blood tone;
  • excessive consumption of salty foods is characteristic of the primary form of the disease. Some people have only this sign;
  • strong weakness and shivering

Signs of acute adrenal insufficiency:

  1.  pallor of the skin
  2.  strong weakness, sometimes a person is in a prostration
  3.  heart rate enhancement
  4.  vomiting and diarrhea;
  5.  cyanotic fingertips
  6.  convulsive seizures
  7.  decrease in the amount of urine emitted;
  8.  soreness in the abdomen
  9.  the appearance of brown rashes, but only if the cause of the disease was a meningococcal infection.

If you do not go to the hospital in time and start treatment, then a coma comes, which can result in death.

Complications

Consequences occur only on the background of the progression of acute adrenal insufficiency, which is also known as a crisis. Very often accompanied by a decrease in the level of glucocorticosteroids — hormones, which produces the adrenal cortex. This can occur with the introduction of insufficient doses of hormones, as well as in the complete absence of treatment. The characteristic features of a crisis can be expressed by several systems:

  • cardiovascular — there is a pallor of the skin, a decrease in blood pressure, cyanosis and cold extremities, a rapid pulse
  • Gastrointestinal tract — wandering tenderness in the abdomen, nausea and vomiting, constipation and diarrhea
  • neuro-psychic — expressed by varying intensity of headaches, inhibition, cramps are often observed

If such symptoms occur, it is necessary to immediately deliver the person to a medical facility where he will be provided with qualified assistance. If this is not done in time, the probability of a lethal outcome is high.

Diagnostics

The basis of diagnostic activities are instrumental examinations of the patient and laboratory studies of blood and urines. But before this doctor should conduct a detailed survey to determine the possible causes of hypocorticism, the presence and severity of symptoms. In addition, the patient is examined, which includes — measuring blood pressure and body weight, as well as assessing the state of the skin and mucous membranes.

The study of blood and urine tests in the laboratory is necessary to establish the level of the content of a hormone that secretes the adrenal cortex. Their values ​​will be reduced. In addition, such analyzes show how different types of metabolism were affected, in particular electrolyte and lipid, protein and carbohydrate.

In order to find out the form of the disease, during the diagnosis, instrumental examinations of the patient are performed:

  1.  Ultrasound;
  2.  MRI is needed for brain, pituitary and hypothalamus studies
  3.  The ECG is performed in order to find out how the heart has changed as the blood composition changes.

Additional consultation of a geneticist is necessary if there is a suspicion of genetic causes of adrenal insufficiency.

Treatment

Patients who suffer from insufficiency of the adrenal cortex, require a lifelong replacement of hormonal drugs. Patients are assigned or injected intravenously with glucocorticosteroids and mineralocorticoids.

Elimination of the causes of hypokorticism consists of taking medications for the treatment of tuberculosis, fungal and viral infections, syphilis. Apply radiation therapy to the affected area of ​​the hypothalamus and pituitary gland. In extreme cases, resort to surgical intervention to eliminate cancer tumors and aneurysms. The effect of such therapy methods is traced by measuring blood pressure, as well as when the patient gradually fixes pigmentation, increases body weight, improves overall well-being.

Acute insufficiency of the adrenal cortex or a crisis develops against the background of the absence of an increase in the dose of the drug in case of an infectious disease. In addition, it progresses in situations where the patient independently stops taking corticosteroids or skips one of the techniques. This condition should be treated by intravenous injection of a large number of solutions with glucose and sodium chloride, substitution of glucocorticoid deficiency with intramuscular injections of synthetic hormones, elimination of the underlying ailment that caused the crisis.

If the patient promptly turned to the specialists for help, and the doctors assigned effective treatment tactics, the prognosis is relatively favorable. In addition, people with such a disease should not miss taking hormone replacement medications or injections, especially with infectious diseases or if there is a need for immediate surgery.