Chronic adrenal insufficiency — a disease that occurs when reducing the production of hormones by the adrenal cortex.
- primary adrenal insufficiency (disease Addison's disease). The disease is caused by the defeat of the adrenal cortex, which do not produce enough hormones;
- secondary failure the adrenal cortex, when hormone production declines
reducing the amount of ACTH — a hormone produced in the pituitary gland and regulating the activities of the adrenal cortex. because of
The cause of primary adrenal insufficiency (Addison's disease) often remains unknown (in
The disease can also occur due to lesions in the adrenal glands:
- autoimmune disease (immune system begins to damage the body's own healthy cells);
- hemochromatosis, scleroderma;
- syphilis, brucellosis;
- metastasis of malignant tumors (lung, breast and other organs);
- adrenalectomy (removal of the adrenal glands) due to tumor disease
- cytostatic treatment;
- prolonged glucocorticoid therapy. This raises the inhibition of the function of the adrenal cortex by type of withdrawal;
- AIDS. It may be necrosis of the adrenal glands.
Secondary adrenal insufficiency develops in diseases of the pituitary gland (often with hypopituitarism).
What's going on?
By reducing the amount of adrenocortical hormone metabolism is disturbed, and the balance of salt and water in the body.
The disease is characterized by:
- general and progressive muscle weakness, increasing fatigue;
- weight loss;
- darkening of the skin, resembling a deep tan. First of all, darkening of the skin occurs on exposed skin (face, neck, hands), in areas of friction skin and skin folds (elbows, palms line the stomach, etc.), a natural pigmentation (nipple breast, scrotum, anus) in places of contact and friction skin and clothing (in pressure gum from pants, belt) in the post-operative scarring. Sometimes against the darkening of the skin has white spots — vitiligo. Brown spots may also appear on the mucous membrane of the cheeks, lips, gums, tongue.
- decrease or loss of appetite;
- decrease in blood pressure;
- dizziness, fainting;
- violations of the
tract: nausea, vomiting, alternating diarrhea and constipation; gastrointestinal
- abdominal pain;
- craving for salty foods;
- apathy, irritability, worsening of concentration, attention, and memory.
In secondary adrenocortical insufficiency color of the skin of patients did not change.
Diagnosis and treatment
To identify chronic adrenal insufficiency is prescribed:
- CBC: anemia is detected, increasing the number of eosinophils in the blood;
- blood chemistry: an increase in the level of potassium and creatinine, reduced sodium, hypoglycemia (blood sugar lowering);
- study of the level of adrenal hormones in the blood and urine: revealed reduction of corticosteroids (cortisol, aldosterone, and others);
- special test — a test with water loading, the sample Thorne, glycemic curve, etc.;
- CT scan allows us to estimate the size adrenal diagnose tubkrkulezny process, calcifications, tumors of the adrenal glands;
- U.S. adrenals and kidneys;
- Various methods for the determination of adrenal autoantibodies — for the diagnosis of autoimmune Addison's disease.
Treatment is aimed, on the one hand, the elimination of the process that caused the defeat of the adrenal glands and, on the other — to fill the lack of hormones.
- Diet for chronic adrenal insufficiency should contain an increased amount of calories, protein, vitamins, salt (
3-10g / day).
- Is necessary to avoid serious physical and mental exertion, not drinking alcohol and sleeping pills.
- When tuberculosis is suspected appointed courses of TB drugs under the supervision of TB specialist.
- Required appointed replacement therapy — a permanent lifelong reception synthetic adrenal hormones (eg cortisol). With the development of acute infectious diseases, surgery should consult with an endocrinologist to adjust the dose of hormones taken.
- Self-lowering doses of hormones or cancellation is unacceptable, as lead to the development of severe complications of the disease — acute adrenal insufficiency.
The course of the disease with early diagnosis and proper treatment is favorable. Women with chronic insufficiency of the adrenal cortex, the possibility of pregnancy and normal delivery.