Small glands located above the kidneys, called ‘adrenal glands’ produce critical hormones for stressful situations. Illness of the adrenal glands as diagnosed by Internal Medicine Specialist in Karachi can put the patient on hormone replacement therapy for life. Read on to know more about adrenal insufficiency, its causes, symptoms, diagnosis and management.

What is adrenal insufficiency?

As mentioned before adrenals are glands located on top of the kidneys which produce stress hormones like: cortisol and aldosterone. Cortisol hormone is also known as ‘stress hormone’ and plays essential role in maintaining blood pressure, heart rate, glucose levels as well as the immune response in the body. Aldosterone, on the other hand, controls the level of potassium and sodium in the blood through the kidneys.

If the adrenal glands don’t produce enough of these hormones, a condition called adrenal insufficiency ensues and the body has trouble with basic functions like maintaining blood pressure among other symptoms.

Adrenal insufficiency can be a result of some other health condition or caused by an autoimmune reaction. Some causes include:

• Tuberculosis, HIV/AIDs
• Bleeding into the adrenal glands
• Fungal and viral infections
• Genetic defects
• Amyloidosis
• Metastatic cancer
• Radiation therapy
• Inflammatory diseases
• Tumors of the adrenal gland or the pituitary
• Chronic use of drugs like glucocorticoids can also cause secondary adrenal insufficiency

What are the types of adrenal insufficiency?

There are three types of adrenal insufficiencies:

• Primary adrenal insufficiency or Addison’s disease: in this type, the adrenal glands are damaged and the primary organs of defect. They produce inadequate levels of cortisol and aldosterone. This condition is also called Addison’s disease.
• Secondary adrenal insufficiency: if there are insufficient levels of cortisol in the body secondary to less stimulating hormone from the pituitary gland of the brain, called adrenocorticotropin hormone (ACTH), the condition is called secondary adrenal insufficiency. This condition is more common than primary adrenal insufficiency. If the signal from the pituitary doesn’t get to the adrenal glands through the ACTH, they don’t make the cortisol hormone and in fact, shrink due to disuse.  
• Tertiary adrenal insufficiency: the ACTH in turn is stimulated by the hypothalamus and a hormone called corticotropin-releasing hormone (CRH). If there is not enough CRH, the pituitary’s ability to make ACTH is also impacted, and tertiary adrenal insufficiency ensues.  

What are the symptoms of adrenal insufficiency?

Adrenal insufficiency presents as:

• Weakness as the glucose levels dip
• Fatigue
• Darkness of skin (in primary adrenal insufficiency)
• Dizziness
• Fluid loss
• Weight loss
• Lack of appetite
• Muscle pain
• Low blood pressure
• Menstrual irregularities in women

Without treatment there is:

• Extreme weakness
• Severe abdominal discomfort
• Kidney failure
• Shock

How is adrenal insufficiency diagnosed?

The diagnosis of adrenal insufficiency is based on thorough history and physical examination, along with relevant clinical examinations such as:

• Blood tests: blood investigations are performed to check the levels of cortisol, sodium, potassium and ACTH in the body.
• X-rays: these are done if calcium deposits are suspected in the adrenal glands.
• ACTH stimulation test: this test is done to check if the low levels of cortisol are a result of primary or secondary illness. Exogenous ACTH is given and cortisol levels are check thereafter. Low levels of cortisol indicate primary illness, while raised levels indicate secondary illness.
• CT/MRI: imaging techniques like CT/MRI are done to evaluate the adrenals and the pituitary gland.

How is adrenal insufficiency treated?

Hormone replacement therapy is the mainstay of treatment for adrenal insufficiency. Since cortisol and aldosterone levels are affected, the treatment options are exogenous hydrocortisone, methylprednisolone and prednisone. For replacement of aldosterone fludrocortisone acetate is prescribed.

In addition, plenty of salt is added to the diet, especially in times of stress, minor illness or infection.

In case of emergency, the treatment regimen involves: intravenous corticosteroids, dextrose (sugar) and saline solution.

Saifee Hospital offers annual checkups with the expert endocrinologist and internal medicine specialists for people with adrenal insufficiency.