A paired organ in the shape of a triangle is located directly above the kidneys. Its mass is approximately 5 g. The main task of the adrenal glands is the synthesis of hormones, which are vital for the human body. This process occurs in the cortex, but under the influence of various adverse factors, it is disturbed. In such cases, the doctor makes a diagnosis of adrenal insufficiency. The course of the disease can be both acute and chronic.
General information and the mechanism of development of pathology
The adrenal glands are composed of the cortical and brain layers. In this case, the latter is considered central and is responsible for the production of hormones, the task of which is to normalize blood pressure. But the diagnosis of "renal failure" is made only with a deficiency of certain substances synthesized in the cortical layer, namely aldosterone and cortisol.
The first is necessary to maintain a normal balance of bicarbonates, sodium, chlorine and potassium.
Cortisol is responsible for the following processes:
- maintaining carbohydrate metabolism;
- accelerating the release of calcium into the blood, reducing the degree of its absorption by bone tissue;
- participation in the breakdown of proteins from amino acids;
- increased fat deposition under the skin of the face and body, burning it on the limbs;
- elimination of inflammatory processes.
The production of hormones is controlled not only by the adrenal glands, but also by the pituitary and hypothalamus. These are the organs of the endocrine system that are located in the skull. The process is as follows: the hypothalamus produces corticoliberin, then this substance enters the pituitary gland and promotes the synthesis of ACTH (adrenocorticotropic hormone), which, in turn, has a direct effect on the work of the adrenal glands. Failure develops when a violation occurs at any stage. Another name for the pathology is hypocorticism.
Disease classification
Since the process of hormone production has triple regulation, their level may decrease due to disruption of one of the organs.
In endocrinology, adrenal insufficiency is divided into the following types:
- Primary. It is characterized by a lesion directly of the paired organ.
- Secondary. It occurs against the background of the development of diseases of the pituitary gland, which as a result produces an insufficient amount of ACTH or does not synthesize it at all.
- Tertiary. It is characterized by the production of a small amount of corticoliberin in the hypothalamus.
Primary adrenal insufficiency is considered the most severe form of the disease.
In some cases, the pathology develops against the background of the normal synthesis of aldosterone and cortisol. This is due to the low sensitivity of receptors to these substances.
By the nature of the course, the disease can be:
- Sharp. Adrenal insufficiency in this case is also called an addison crisis. With this form of pathology, emergency care should be provided to the patient, otherwise the disease may result in death.
- Chronic. Adrenal insufficiency in such cases can have several stages. Patients can live with a disease of a chronic nature for many years if they regularly visit their doctor to correct the therapeutic regimen.
Causes
The adrenal glands are a body with good compensatory abilities. But under the influence of provoking factors, a serious failure can occur in their work.
The causes of primary adrenal insufficiency are the following diseases and conditions:
- Autoimmune pathologies. More than 90% of cases of hypocorticism are associated with an attack by antibodies in the cells of one's own body.
- Underdevelopment of the adrenal cortex. An anomaly is congenital.
- Allgrove's Syndrome. This is a condition characterized by resistance to ACTH.
- Tuberculosis.
- Amyloidosis. The development of this pathology is accompanied by the deposition in the adrenal glands of an excessive amount of protein formed against the background of a prolonged course of a chronic disease.
- Adrenoleukodystrophy. This is a hereditary pathology in which an excess amount of fatty acids accumulates in the body, provoking the occurrence of disorders in the work of the adrenal glands and some parts of the brain.
- Tumor metastases in malignant diseases.
- Adrenal hemorrhage. As a rule, it occurs due to serious infectious pathologies: meningitis, scarlet fever, sepsis, diphtheria.
- Vascular thrombosis, through which the adrenal glands are fed.
- Malignant neoplasms in the organ itself.
- Human immunodeficiency virus, in which necrosis of the adrenal gland occurs.
- Kearns syndrome. It is characterized by damage to the muscles and eye tissue.
- Smith Syndrome - Opica. It is a combination of several pathologies at once: a violation of mental development, a small volume of the cranium, anomalies in the structure of the genitals.
In newborns, adrenal insufficiency may be the result of hypoxia that has occurred during childbirth.
Causes of the secondary form of the disease:
- Pathologies of an infectious nature.
- Hemorrhage developed on the background of receiving any kind of injury.
- Malignant neoplasms in the pituitary gland tissue.
- Autoimmune diseases.
- The destruction of the pituitary gland. In most cases, it occurs against the background of radiation, surgery, or prolonged therapy with glucocorticoid drugs.
- Congenital pathologies of the pituitary gland, in which the mass of the organ is less than normal.
The tertiary form of the disease can also be both hereditary and acquired in nature. It can appear due to malignant neoplasms of the hypothalamus, its irradiation, hemorrhage in the organ, pathologies of an infectious nature.
Symptoms
The severity of symptoms depends on the rate of damage to adrenal tissue. If they die very quickly, an addison crisis develops, slowly - chronic hypocorticism.
Acute adrenal insufficiency has the following symptoms:
- pallor of the skin that occurred suddenly, while the fingertips acquire a bluish tint;
- extreme weakness;
- heart palpitations;
- vomiting
- pain in the abdomen, not having a specific location;
- frequent episodes of diarrhea;
- rare urination.
Some patients experience muscle cramps. In addition, if the cause of the disease is a meningococcal infection, a rash having a black-brown color is added to the above symptoms of adrenal insufficiency. When pressed on the skin with clear glass, it does not disappear.
Adrenal insufficiency in children can develop against the background of the usual ARVI, vaccination, intestinal diseases, stressful situations. In addition, babies born from pelvic presentation or with hypoxia are at risk. Symptoms of adrenal insufficiency in young children are the same as in adults.
The acute form of the disease in most cases develops without any previous warning signs. With a sharp deterioration in well-being, it is necessary to call an ambulance team. In the absence of timely intervention by doctors, the patient falls into a coma, which often ends in death.
In both men and women, symptoms of chronic adrenal insufficiency appear after being in a stressful situation. As provoking factors can be: psycho-emotional instability, various injuries, infectious diseases.
Chronic adrenal insufficiency has the following symptoms:
- Increased pigmentation of the skin and mucous membranes. This condition occurs with primary hypocorticism. And with secondary adrenal insufficiency, and with tertiary, staining of the mucous membranes and the skin never occurs. First of all, those areas that are least often covered by clothes (neck, face, palms) begin to darken, as well as areas that always have a darker shade (scrotum in men, armpits, crotch, areola of the nipples). In addition, the mucous membrane of the cheeks, tongue, gums, vagina and rectum is stained. The degree of hyperpigmentation in adrenal insufficiency directly depends on the prescription of the pathology. It can be either light, resembling a tan, or pronounced, manifesting itself in dark areas and creating the effect of very dirty skin. With the autoimmune nature of primary hypocorticism, vitiligo spots (completely depigmented areas) appear on the stained areas.
- Weight loss. This is due to a significant lack of nutrients in the body. At the same time, a person can lose both an insignificant amount of kilograms and more than 15, which leads to malnutrition.
- Behavioral Disorders. With the development of primary hypocorticism, patients complain of: constant irritability, apathy, pronounced muscle weakness, depression. Against the background of these conditions, both partial and complete loss of performance occurs.
- Digestive disorders. The characteristic signs of primary chronic adrenal insufficiency are: lack of appetite; nausea; pain in the abdomen, not having a clear localization; anorexia; vomiting alternating diarrhea and constipation.
- Lowering blood pressure. A feature of the disease is a decrease in the rate of 5-10 mmHg. In this case, patients assess their condition as satisfactory.
- Craving for salty foods, trembling muscles and weakness with an empty stomach. These conditions disappear after a meal. With secondary adrenal insufficiency, patients do not feel cravings for salty foods. Weakness and trembling in them occurs several hours after eating.
In addition, in women, a symptom of adrenal insufficiency is a decrease in libido and a cessation of body hair growth.
Parents should show the child to the doctor if he has: drowsiness, vomiting for no reason, craving for salty foods. If, against the background of these conditions, darkening of scars, folds, and mucous membranes in the oral cavity occurs, this indicates the presence of chronic adrenal insufficiency.
Diagnostics
The doctor may suspect the presence of pathology already during the survey and examination of the patient.
To confirm the diagnosis and determine the form of the disease, the specialist prescribes the following laboratory tests:
- Blood analysis. The doctor is interested in the level of cortisol (in case of insufficiency, it is always reduced), ACTH (in the primary form, its indicator increases, in other cases it decreases), aldosterone.
- Analysis of urine. The development of the disease is accompanied by a decrease in cortisol metabolites in the primary and secondary form of pathology.
According to indications, a stimulation test can be prescribed. Its essence is as follows: the patient is taken blood and determine the level of cortisol in it. Then he is injected with synthetic ACTH. A second study is carried out after 30 and 60 minutes. Normally, the cortisol indicator increases at least 4 times. If its level is lower, this indicates the presence of adrenal insufficiency. The test is carried out at 08:00, as it is at this time that the greatest activity of the necessary hormones is observed.
In addition, the doctor prescribes an examination using instrumental methods:
- Ultrasound of the adrenal gland. With difficult visualization, the patient is sent for computed tomography.
- MRI of the brain. During the study, the state of the pituitary and hypothalamus is assessed.
Based on the results of laboratory and instrumental diagnostics, the doctor can make an accurate diagnosis and determine which form of the disease the patient suffers from (primary, secondary or tertiary). After this, it is necessary to find out the degree of metabolic disturbance. For this, the patient must donate blood for a general analysis. In addition, an electrocardiogram is mandatory. This study allows us to evaluate the condition of the heart and how much changes in the electrolyte composition of the blood affected its work.
Diagnosis of the disease in children is carried out according to the same scheme as in adults.
Treatment
In an attack of acute adrenal insufficiency, an ambulance team must be called immediately. Upon arrival at the hospital, the patient is immediately placed in the intensive care unit.
Treatment of adrenal insufficiency in such cases includes:
- The introduction of a large amount of glucose and saline intravenously. This is necessary to normalize the water-electrolyte balance. At the same time, sodium and potassium in the blood are constantly monitored.
- Intravenous administration of synthetic hormones. In most cases, Prednisone is used for this purpose (Hydrocortisone in young children). After the body leaves the shock state, the drug is administered intramuscularly.
- Normalization of blood pressure. With a significant decrease in the indicator, “Mesaton”, “Dobutamine”, “Adrenaline” or “Dopamine” are administered to the patient.
- Elimination of the pathology that provoked the attack. For this, both conservative and surgical methods of treatment can be used.
After stopping the seizure, the patient is transferred to the general ward.
According to clinical recommendations, with adrenal insufficiency of a chronic nature, the patient must enter synthetic glucocorticoids. The mild degree of the disease is corrected by the drug "Cortisone". If the pathology is pronounced, the doctor additionally prescribes Prednisolone and Fludrocortisone. The latter is an analogue of the mineralcorticoid aldosterone.
This combination is due to the fact that it is impossible to carry out treatment with glucocorticoids alone. Otherwise, adults feel significantly worse, and children have poor weight gain, dehydration, and mental retardation.
Monitoring the patient’s health is carried out monthly, after normalization of all necessary indicators - 4 times a year. If necessary, adjustments are made to the treatment regimen.
Power Features
Diet with adrenal insufficiency plays an important role.
Correction of the diet is carried out in accordance with the following principles:
- The calorie content of dishes should be increased by 25%.
- It is necessary that the body receives a sufficient amount of animal protein. To do this, the menu should always contain fish and meat.
- Easily digestible carbohydrate foods are recommended. To replenish the level of fat, you must regularly include butter in the menu.
- The amount of salt can be left unchanged. To a minimum, it is necessary to reduce the consumption of prunes, apricots, figs, raisins and exclude bananas and baked potatoes from the diet. This is explained by the need to limit the intake of potassium salts in the body.
- Do not eat fried foods. Such dishes contain toxic compounds that create an additional burden on the internal organs.
- The menu should contain daily freshly squeezed juices, berries and fruits.
Often, against the background of adrenal insufficiency, patients develop a stomach ulcer and duodenal ulcer. In the presence of this pathology, the doctor adjusts the diet.
Effects
Against the background of aldosterone deficiency, dehydration occurs. This condition gradually progresses, as sodium continues to be lost in large quantities. At the same time, excessive accumulation of potassium occurs. A natural result is a malfunction in the functioning of the digestive system. In addition, the work of the heart is disrupted. When potassium rises to 7 mmol / l, it can stop.
Cortisol deficiency is dangerous because glycogen production is disrupted. This substance is the main form of glucose storage in the liver. With its deficiency in the pituitary gland, the process of increased production of ACTH starts, which as a result provokes the synthesis of not only cortisol, but also melanotropin. The latter is the cause of hyperpigmentation of the skin and mucous membranes.
Prevention
The state of the Addison crisis is virtually impossible to prevent. When it appears, the main condition for a successful prognosis is timely medical care.
Prevention of chronic adrenal insufficiency is the implementation of maintenance therapy, which, in turn, is based on the use of synthetic hormones. Dosage and regimen are calculated only by the attending physician individually. If you feel worse, the specialist makes adjustments to the appointment.
Finally
The adrenal glands are a paired organ producing vital substances. Under the influence of various adverse factors, the process of hormone production is disrupted. Against the background of cortisol and aldosterone deficiency, adrenal insufficiency develops.
The disease can take several forms: primary, secondary and tertiary. The first is considered the most dangerous, since it is it that is associated with the defeat of the adrenal glands themselves. In other cases, the work of the pituitary and hypothalamus is disrupted.
Pathology can also have both acute and chronic nature of the course. In the first case, you must immediately call an ambulance crew. This is due to the fact that such a condition without timely intervention leads to death. Treatment of a chronic form is carried out using synthetic hormones.