28.06.2020

Adrenal insufficiency: symptoms, treatment. Adrenal insufficiency Modern methods of treatment of secondary adrenal insufficiency

The disease provokes metabolic disorders, in particular, water-salt metabolism.

Manifestations of this disease, if untreated, can lead to irreversible consequences, in particular the development of coma or clinical death.

Dysfunction of the adrenal cortex can be of 2 types:

sharp;
chronic.

Chronic adrenal insufficiency also has 2 forms:

primary;
secondary.

Primary adrenal insufficiency is called Addison's disease or hypocortisolism syndrome and occurs due to damage to the cortex of the endocrine glands.

In turn, secondary adrenal insufficiency is a manifestation of disturbances in the functioning of the pituitary gland, in which the secretion of ACTH decreases.

Factors that cause primary hypocortisolism may be:

infectious diseases;
immunity disorders;
tumors of the adrenal cortex;
metastases of oncological tumors;
during long-term use of hormonal drugs.

The secondary form of the disease develops when there are disturbances in the functioning of the brain.
The causes of secondary hypocortisolism are:

neoplasms in the pituitary gland;
head injuries;
surgical intervention in the brain area;
treatment with radioactive rays;
severe drug or alcohol intoxication;
hypopituitarism.

In more than half of the cases, the causes of primary hypocortisolism are not diagnosed. Most often, this pathology manifests itself in females and often in adolescents.

All cases of the disease in children are taken under special control.

Chronic adrenal insufficiency has a number of characteristic symptoms:

Decreased muscle tone that progresses over time.
Weight loss due to loss of desire to eat.
A change in pigmentation towards its increase, in particular in visible areas of the body and, especially, in places of rubbing with clothing.
The appearance of characteristic dark or white spots on the affected skin.
Hypotension, often causing fainting.
Increased desire to eat salty foods.
Decreased intellectual abilities and worsening mood.

Secondary adrenal insufficiency manifests itself with the same symptoms, but unlike the primary type, it does not cause a strong change in pigmentation.

When the pituitary gland is damaged, only cortisol synthesis is disrupted, so all symptoms are less pronounced.

Primary adrenal insufficiency and primary hypocortisolism manifests itself in women as hair loss in the pubic or armpit areas.

Signs of adrenal insufficiency develop only after 90% of all gland tissue has been destroyed.

Acute adrenal insufficiency is a coma that occurs as a result of a crisis of Addison's disease.
It can develop under the following conditions:

How a complication occurs in the chronic form of the disease.
After removal of the adrenal glands.
If you suddenly stop taking hormones.
Due to autoimmune thyroiditis.

Acute adrenal insufficiency in children can be triggered by difficult childbirth and the occurrence of microstrokes in the adrenal parenchyma.

Other provoking factors of a non-pathological nature may be:

blunt abdominal trauma;
taking a large number of anticoagulants;
abdominal surgery;
blood poisoning;
inflammation of appendicitis;
severe form of burn injury or frostbite.

A decrease in the synthesis of hormones from the adrenal cortex leads to the fact that the body ceases to adapt to stress.

The crisis of Addison's disease manifests itself with specific symptoms:

the occurrence of prostration;
loss of consciousness due to a sharp decrease in pressure;
severe vomiting;
diarrhea, which leads to a complete disruption of the body’s water-salt metabolism;
the appearance of a characteristic sign - the smell of acetone;
convulsive conditions;
the occurrence of heart failure.

The skin may suddenly darken.

The crisis state of hypocortisolism syndrome can have three forms of clinical manifestation:

Disturbances in cardiovascular activity;
Gastrointestinal disorders;
Mental disorders.

Any manifestation of a crisis can occur spontaneously and is difficult to treat. Failure to provide assistance results in death.

In the chronic course of the disease, it is important to constantly maintain correct hormonal therapy so that a crisis does not arise.

Symptoms of cardiovascular disease

If the acute form is manifested by signs of impaired cardiovascular function, the patient will have the following symptoms:

paleness of all integuments;
acrocyanosis;
hands and feet become cold to the touch;
heart rhythm disturbance;
decreased blood pressure;
disappearance of pulse.

With cardiac disorders, urinary retention may occur.

Symptoms of gastrointestinal disorders are as follows:

spasms in the stomach and intestines;
vomiting and nausea;
diarrhea, often bloody;
unstoppable flatulence.

Such signs resemble the condition of an acute abdomen and can be confused with poisoning. Only test results will indicate clinical differences.

This type of pathology manifests itself:

migraines;
meningeal symptoms;
delusional;
state of stupor;
lethargy.

In this case, acute adrenal insufficiency consists of three phases of development:

Initially, weakness and skin pigmentation increase, and nausea appears.
With the prolonged development of the pathology, the symptoms intensify, leading the person to an incapacitated state.
The manifestation of the last stage is the incapacitated state of the patient’s body.

Coma is the final stage of an acute state of adrenal insufficiency. It requires immediate hospitalization of the patient and provision of resuscitation care.

Diagnosis of adrenal insufficiency is carried out in several ways:

Carrying out blood screening, which reveals a reduced amount of hemoglobin and an increased amount of eosinophilic bodies.
Conducting a urine test to determine low levels of adrenal hormones.
Carrying out ultrasound diagnostics.
Use of computed tomography for suspected severe kidney infections.
If primary hypocortisolism is suspected, endocrinologists perform special tests, including tests for autoimmune antibodies.
Fine needle biopsy of adrenal cortex tissue.

The initial appointment with an endocrinologist begins with collecting information about the patient’s condition, as well as examining his body.

To confirm the diagnosis of a secondary form of hypocortisolism, an MRI of the brain is also performed.

Acute adrenal insufficiency and treatment of acute adrenal insufficiency is carried out using the following methods:

Use an isotonic chloride solution in a batch of 2 liters per day.
Use a glucose solution.
Prednisolone is administered intravenously, gradually reducing its concentration until the patient’s condition stabilizes.
In the presence of an infectious provoking agent, antibacterial therapy is started.

For concomitant signs of adrenal insufficiency that are related to gastrointestinal or cardiac disorders, symptomatic treatment is used.

During the chronic form of the disease, the following therapy is carried out:

eliminate the original cause of glandular insufficiency;
replace necessary hormones to normal levels;
corrects the functioning of affected body systems;
use vitamin-mineral and enzyme complexes to strengthen the immune system.

To eliminate the causes of endocrine gland insufficiency, the following medications and methods of therapy are used:

antibiotics;
antimycotics;
anticancer therapy;
the use of surgery to remove tumors.

Treatment of the primary form of chronic failure is carried out using hormone replacement therapy.
In this case, the following drugs may be prescribed:

Cortisone;
Cortef;
Prednisolone;
Didn't work;
Retabolil.

Treatment is considered effective if the manifestations of the disease disappear and the indicators of the body systems return to normal.

To carry out preventive measures for adrenal insufficiency, the following tips are used:

do not overload the body;
do not drink alcoholic beverages;
do not abuse psychotropic drugs;
When taking hormonal therapy, you cannot change it yourself.

If you follow all preventive measures and regularly use medications prescribed by a specialist, you can achieve a positive effect.

Women of childbearing age who are being treated for chronic adrenal insufficiency are able to conceive normally and give birth to a healthy baby.

If adrenal gland function is insufficient, a special diet is prescribed.
It is based on the following principles:

an increase in protein foods in the diet;
increasing calorie intake;
using foods rich in vitamins B and C;
enriching the diet with salty foods.

Interesting!

The use of the special drug Sanasol helps saturate the body with potassium and sodium chloride. Its use has contraindications in the form of renal failure.

A favorable treatment outcome depends on timely prevention of crises and regular use of hormonal therapy.

In this case, it is necessary to take into account the conditions for recovery from infectious diseases that provoked the development of adrenal insufficiency.

Adrenal insufficiency or “hypocorticism” is a syndrome associated with pathology of the adrenal zone of the kidneys, as a result of which hormonal disorders occur in the human body. The adrenal cortex is responsible for the functions of the endocrine glands and the normal hormonal balance of each person. Mostly the disorder occurs in people over 30 years of age.

Occurs in acute or chronic form. The chronic form, due to its latent period, may not manifest itself for a long time. The only thing is that the patient will constantly be drawn to salty foods, which is unlikely to be a cause for concern for him. In the acute form in a person, against the background of hormonal imbalance, symptoms of adrenal insufficiency often arise spontaneously over a short period of time.

The disease is often accompanied by signs of hypotension, shortness of breath, and convulsions until the patient loses conscious activity. This happens if, in the process of treating pathology of the adrenal cortex, the patient refuses to comply with medical requirements, skips doses of medications or drinks them below the prescribed norm.

The adrenal zone, pituitary gland and hypothalamus of the brain are usually responsible for the regulation of gluco- and mineralocorticoids. Depending on which of these organs the pathology occurred in the patient, the following types of hypocortisolism are observed:

primary is formed due to damage to the adrenal glands themselves;
secondary is determined against the background of diseases of the pituitary gland, in this case there is insufficient synthesis of adrenocorticotropic hormone (ACTH) or its production stops altogether.
tertiary occurs due to damage to the hypothalamus, the center where the production of corticoliberin decreases.

Considering the decrease in hormone production against the background of a disease of any organ responsible for the balance of hormones in the body, hypocortisolism can also manifest itself as a result of the normal function of the adrenal glands, including the well-functioning functioning of the pituitary gland and hypothalamus. A phenomenon such as cortisol or aldosterone occurs as a result of reduced sensitivity of the receptors that process such hormones.

As a rule, the primary form of hypocortisolism is experienced more severely by patients compared to the secondary or tertiary, it all depends on the symptoms and the form in which the disease occurs:

Acute is most often observed in the form of Addison or Waterhouse-Friderichsen syndrome, the latter is detected if hemorrhage has been detected in the adrenal tissue. This phenomenon is considered dangerous, and therefore requires more careful attention from medical personnel to quickly eliminate the pathology and save human life.
The chronic form is often rarely detected, as it is sluggish in nature. The patient usually learns that a pathological process has begun in the adrenal glands after some time. However, with the right approach to treatment, it is possible to control the course of a chronic disease for several years.

Symptoms of adrenal cortex dysfunction often do not appear immediately, but only at the moment when practically nothing remains of healthy adrenal tissue. Specifically, the disease is detected only during the period of bilateral damage to the adrenal cortex.

As you know, the adrenal glands are a paired organ that works together; if, for example, one side partially does not perform its basic functions, then the second healthy side performs it, for this reason the patient has no visible symptoms of adrenal insufficiency.

Due to what reasons can adrenal insufficiency develop:

congenital anomaly of the adrenal glands in a child;
autoimmune disease;
not fully formed adrenal cortex, due to external or internal negative reasons;
infection with tuberculosis bacillus;
disorders of protein metabolism that cause protein deposition in the adrenal cortex;
genetic malfunction in the functions of the hypothalamus and pituitary gland;
metastasis and tumors in the kidneys;
circulatory disorders in the adrenal zone.

In addition, infectious processes provoked by meningococcal bacteria in HIV, scarlet fever, diphtheria, sepsis or death of adrenal tissue can cause symptoms of adrenal deficiency. The risk group mainly includes infants and newborns who experienced prolonged asphyxia during childbirth or were born with congenital pathologies due to difficult childbirth.

If we talk about the secondary and tertiary forms of the disease in the pathology of the pituitary gland and hypothalamus of the brain, then the main reasons may be the following factors:

viral infections;
head injuries;
acute disturbances in the blood circulation of the brain;
benign or malignant tumor of the left or right hemisphere of the head;
surgical operations;
consequences of brain cancer treatment with radiation.

With symptoms of adrenal insufficiency (Addison's disease), a severe form of metabolic disorder occurs, sodium is excreted from the body, potassium is retained, which leads to severe dehydration. The patient also experiences disturbances in electrolyte and water-salt balance, as a result of which the entire body suffers, with greater damage to the cardiovascular and digestive systems.

The patient becomes more susceptible to stress due to a deficiency in his body of cortisol, a stress hormone that helps stabilize a person’s condition after experiencing negative emotions. During illness, the adrenal glands produce cortisol in small quantities or not at all. Deviations also include disorders of carbohydrate metabolism and glycogen synthesis in the body.

According to statistics, the first signals of illness usually appear against the background of low stress resistance and decreased immunity due to various injuries, complications of infectious processes and other equally dangerous diseases.

You can suspect that you have symptoms of adrenal insufficiency based on the following characteristic signs, which mainly manifest themselves against the background of stress, infectious processes caused by injury or any cold.

Darkening of the skin and mucous tissues

The most pronounced sign of chronic disease of the adrenal cortex is hyperpigmentation, in the form of excessive coloring of certain areas of the body. The reason for this is the increased production of ACTH, a substance that provokes the synthesis of melanocytes - the cells responsible for tanned skin color.

Increased skin pigmentation when the adrenal zone is affected depends on the severity of the disease. First, the bare areas of the skin that are most often exposed to ultraviolet rays darken: the skin of the face, neck and hands. From the mucous membranes of the patient, darkening of the line of the lips, gums and palate is recorded.

The most noticeable signs of Addison's disease are darkening of the fate lines on the palms, where the edges of clothing come into contact with the skin. In these places, the patient has a bronze skin color, somewhat reminiscent of a muddy shade. For this reason, the disease has another name - “bronze disease”.

Sometimes such symptoms in adrenal pathology may be absent even despite the presence of other signs characteristic of the disease. This does not mean that everything is fine with the adrenal glands; perhaps the person develops “white Addisonism”, to confirm which the patient needs to undergo a more thorough diagnosis.

Weight loss

A sign of Addisonian crisis may be indicated by a sudden weight loss of 5 or more kilograms against the background of a decrease in gastrointestinal metabolic processes, impaired protein synthesis and a lack of nutrients in the patient’s body.

Severe weight loss manifests itself in the form of a significant loss of muscle mass with preservation of subcutaneous fat; increase in general weakness; signs of asthenia and low performance. The patient becomes less emotional, more irritable, lethargic and apathetic, and his tendency to depressive disorders increases.

Gastrointestinal disorders

Expressed in the form of the following symptoms:

frequent refusal of the patient to eat, up to the manifestation of anorexia;
nausea accompanied by intermittent abdominal pain;
changes in stool character;
spontaneous vomiting without previous symptoms, nausea and headache.

Low pressure

The most common and concomitant sign of adrenal pathology is arterial hypotension. In the initial stage, the patient’s blood pressure usually decreases due to a sudden change in body position from the treating one to a horizontal one or due to prolonged standing or stress. Hypertensive patients themselves often do not notice this, since their blood pressure stabilizes. Those who previously had normal blood pressure are more likely to feel it.

If, with the primary signs of an Addisonian crisis, the patient often craves salty foods, has digestive tract disorders, and has arterial hypotension, then with the secondary form such symptoms are usually absent.

However, other symptoms may be present:

the skin and mucous membranes do not darken, but, on the contrary, acquire a pale tint.
failures in the coordination of small movements.
rapid pulse beats.
feeling of hunger, weakness, headache with dizziness.
severe chills and increased activity of the sweat glands.
instant weight loss, lowering blood sugar mainly after eating after some time.

To begin treatment for adrenal insufficiency, it is important for the doctor to correctly diagnose the form of the disease using computer imaging. This approach allows the doctor to select the most correct ways to solve the problem, prescribe individual therapy, and select appropriate medications.

Competent diagnosis is important, even after the doctor has been able to find out all the symptoms observed in the patient. Its essence lies in a complete external and internal examination of the patient, allowing the doctor to draw up a detailed picture of the course of the disease from the diagnostic results obtained.

What diagnostic techniques can be used to examine a patient:

Ultrasound. Allows you to visualize the affected area, confirm the presence or absence of adrenal pathology and other disorders.
CT scan of the adrenal glands is prescribed as an additional technique.
MRI of the brain is necessary to study pathologies of the pituitary-hypothalamic system.
Blood tests are taken to determine the amount of cortisol, aldosterone synthesis in the blood and ACTH levels.
Electrocardiograms are needed to decipher heart failures.

If a diagnosis cannot be established, the doctor prescribes an additional ACTH test, which is necessary to determine cortisol. To do this, the first control result is taken from the patient for the level of cortisol in the blood, then the same analysis is performed after the administration of the synthesized ACTH drug after approximately 30 minutes, and again after 60 minutes to compare all the results.

A test for the treatment of adrenal insufficiency is prescribed in the morning, since it is at this time that the level of cortisol in the blood rises against the background of natural phenomena in the body. If along the way the result indicates an increase in cortisol by less than 550 nmol/l, this indicates the presence of adrenal pathology in the subject. And only after the diagnosis has already been established, the doctor determines the degree of the body’s immune defense, including dysfunction of electrolyte, protein, carbohydrate and lipid metabolism by collecting venous blood.

An important goal of the treatment process is to compensate for hormone deficiency by introducing a certain dose of synthetic drugs into the human body. These include glucocorticoids, which are prescribed taking into account the manifestation of side effects, their activity and the duration of action of the drugs. If this is a mild degree of insufficient production of hormones, then Cortisone is prescribed; for more severe cases, in addition to this treatment, Prednisolone and Fludrocortisone are prescribed.

Treatment always involves the use of Fludrocortisone, an analogue of the mineralocorticoid aldosterone, in conjunction with glucocorticosteroid drugs. Since the use of glucocorticosteroids alone, especially in children, can provoke impaired psychomotor development, cause dehydration, poor weight gain, and even death due to a high dose of potassium in the blood.

Glucocorticosteroid hormones are prescribed to patients starting from adolescence, mainly for the treatment of mild autoimmune deficiency and adrenoleukodystrophy. In other cases, there is a risk of deterioration in health with an increase in the chances of developing a crisis due to loss of salts. Fludrocortisone allows you to restore the content of sodium, potassium and renin in the blood.

The following symptoms may indicate that the patient needs to reduce the dose of Fludrocortisone:

puffiness of the face;
headache;
restless sleep;
hypertension;
the presence in the patient’s blood of an increased amount of sodium and a low amount of potassium.

However, if the patient lives in a hot climate, then in this case he needs a large dose of Fludrocortisone, since due to the high temperature, during heavy sweating, an intense release of sodium along with sweat can occur. If a pregnant woman is undergoing treatment, then she is prescribed this drug starting from the second trimester.

Surgery for adrenal insufficiency is prescribed if the patient is admitted to the hospital with a high fever caused by an infectious disease. In this case, there is always a risk of deterioration of the patient’s condition as a result of an Addisonian crisis, when, to eliminate the disease, a high dose of a glucocorticoid drug is sharply administered for the next 2–3 days after the patient’s admission to the hospital.

Often, an acute course of the disease occurs if the patient decides to refuse to take glucocorticoid drugs or reduces the recommended dose when he develops an infectious process.

Patients with this disease are in the intensive care unit, where they receive the following types of treatment:

Restoration of water and electrolyte disturbances through intravenous administration of sodium chloride and glucose. In the process of administering a sufficient amount of glucose, sodium-potassium metabolism in the blood is also monitored;
Replacement of glucocorticoid deficiency by intramuscular injections with synthetic drugs. The main drug is Prednisolone, it is prescribed at a dose of 2.5–7 mg of the patient’s total body weight. This treatment involves drip or jet administration of the medicine through veins or intramuscularly after the symptoms of shock have been relieved.
Prescribing drugs with a vasopressor effect such as Dobutomin, Dopamine, Mezaton, Adrenaline (to reduce symptoms of low blood pressure);
Treatment of the disease necessarily includes drugs with antiviral, antifungal or antibacterial effects, depending on the disease that caused the crisis. Often such treatment is necessary during the period of preoperative intervention to stabilize the patient's condition.

Patients are transferred to the general ward only if doctors manage to normalize the patient’s blood pressure and restore the level of potassium-sodium balance in the body. Then the dose of mineralocorticoids is reduced to the normal dose, and glucocorticoid drugs are additionally administered in tablet form.

The most appropriate for hypocorticism are preventive measures aimed at maintaining maintenance therapy based on the administration of glucocorticoids. At first, such drugs are prescribed by a doctor, then, as soon as the patient’s condition becomes stable, patients themselves, under the supervision of a doctor, can take steroid hormones for preventive purposes.

Given the severity of the acute development of hypocortisolism, it is important to immediately see a doctor as soon as the first symptoms begin to appear. Depending on the severity of the disease, the specialist will prescribe a minimum or increased dose of hormonal medications.

If during the examination it turns out that the patient often has to deal with situations when his production of any hormones decreases due to illness, then he is prescribed increased intake of hormonal drugs for the next 2-3 days. Therefore, in order to avoid complications, in addition to the oral route, the patient’s therapeutic course also includes parenteral administration of drugs.

Related publications

The adrenal glands are paired glands that are an integral part of the endocrine system. In women, they play an important role in stabilizing hormonal levels and maintaining the normal functioning of the body. The glands synthesize corticosteroid hormones, adrenaline, control the synthesis of sex hormones, and water and electrolyte balance. If, due to certain reasons, disturbances occur in the adrenal glands, this affects the general well-being of the woman.

Adrenal insufficiency (hypocorticism) is a condition in which the secretion of hormones from the adrenal cortex is significantly reduced. This syndrome can be primary - associated directly with disorders in the adrenal glands, or secondary - the root cause lies in the dysfunction of the hypothalamic-pituitary system. Manifestations of pathology in women are very diverse and cause serious disruptions in the functioning of the entire body, including coma and death. To avoid the serious consequences of adrenal insufficiency, it is important to diagnose the pathology in time and carry out treatment.

Adrenal insufficiency (AI) can be primary or secondary. The primary form (Addison's disease) develops due to disorders directly in the adrenal cortex.

The causes of violations may be:

organ infections;
tuberculosis;
tumor formations;
metastasis to the adrenal glands from cancers in other organs;
long-term use of hormones.

Secondary hypocortisolism is a syndrome that occurs against the background of disorders in the pituitary gland, in which there is a decrease in the synthesis of ACTH. Its reasons are:

pituitary tumors;
brain surgery;
hemorrhages;
head injuries;
radioactive exposure;
hypopituitarism.

About 50% of cases of primary NN remain with an unknown etiology (idiopathic atrophy). It develops if a woman has more than 85% of her glandular tissue affected.

In the body, under the influence of unknown reasons, antibodies to 21-hydroxylase are formed, which have a destructive effect on the cells of the cortical layer of the glands. More than half of patients with primary hypocortisolism are diagnosed with autoimmune lesions of other organs.

In the primary form of the pathology, the secretion of cortisol and aldosterone decreases, as a result of which metabolism and water-salt balance are disrupted. There is a loss of sodium salts, an accumulation of potassium, and hypoglycemia develops against the background of a decrease in glycogen synthesis.

In the secondary form of the syndrome, only a lack of cortisol occurs, and the production of aldosterone remains normal. Therefore, it proceeds relatively easily compared to the primary form.

What is thyroid-stimulating hormone and for what symptoms is a test prescribed? Read useful information.

Learn about the benefits of the 9th table diet for diabetes and the rules of nutrition for the disease from this article.

Symptoms of adrenal insufficiency can vary, depending on the form and degree of insufficiency.

Manifestations of primary hypocortisolism in women:

hyperpigmentation of the skin and mucous membranes - due to cortisol deficiency, ACTH increases, darkening occurs primarily in open areas of the skin that are exposed to UV;
dyspeptic disorders - poor appetite, abdominal pain, bowel dysfunction, nausea, due to the leaching of sodium from the body, a strong addiction to salty foods appears;
weight loss - occurs due to nutritional deficiency, protein metabolism disorders, weight loss due to hypocortisolism - a consequence of loss of muscle mass;
deterioration in performance, general weakness;
a significant drop in pressure, dizziness, which in the first stages of the disease are orthostatic in nature.

Secondary deficiency occurs with no signs of aldosterone deficiency. It is characterized by:

hypotension;
dyspeptic disorders;
passion for salty things.

Hyperpigmentation, which is considered one of the typical manifestations of primary NN, is absent in the secondary form of the pathology.

The most dangerous condition of adrenal insufficiency in case of untimely medical care is Addisonian crisis with subsequent development of coma.

A crisis is characterized by:

a sharp drop in blood pressure, which can lead to loss of consciousness;
increased vomiting;
diarrhea causing dehydration;
convulsions;
heart failure;
smell of acetone.

Acute hypocortisolism can occur in 3 forms, depending on the prevalence of symptoms:

cardiovascular;
gastrointestinal;
neuropsychic.

Warning! It is important to prevent a serious condition and seek medical help in a timely manner. Addisonian crisis is very difficult to control and can lead to the death of the patient.

Diagnostics

To confirm the diagnosis, a whole range of studies is carried out. The doctor collects and evaluates the medical history, and listens to the patient’s complaints. To prescribe the correct treatment, it is necessary to find out the root cause and form of the deficiency.

One of the most informative studies is ultrasound of the adrenal glands. Additionally, a CT or MRI of the organ may be required. If secondary hypocortisolism is suspected, a CT scan of the brain is performed.

An analysis is required to determine the level of adrenal hormones. With adrenal insufficiency, cortisol levels fall, and the level of free cortisol 17-OX in the urine also decreases. Sometimes an ACTH stimulation test is recommended, which measures the level of cortisol in the blood 30 and 60 minutes after ACTH administration. To confirm secondary hypocortisolism, an insulin hypoglycemia test is performed. Primary NN is manifested by hypercalcemia, hyponatremia, leukopenia, and lymphocytosis in the blood.

The treatment tactics that the doctor will select depends on the causes of the syndrome in the woman and the stage of the pathological process. Treatment goals: stop the primary disease, compensate for hormonal deficiency.

In case of acute adrenal insufficiency, the action plan should be as follows:

the patient is admitted to the hospital;
NaCl solution up to 2 liters per day is administered intravenously;
it is necessary to administer a glucose solution, as well as Prednisolone, followed by a reduction in its dosage.

After stabilization of the condition, maintenance hormonal therapy with glucocorticoids and mineralcorticoids is carried out, which is permanent:

Cortisone;
Cortef;
Didn't work;
Retabolil.

For mild hypocortisolism, take Cortisone or Hydrocortisone; if the disease is advanced, use combinations of Cortisone or Hydrocortisone with Prednisolone. If the therapy is effective, patients experience a decrease in skin pigmentation, blood pressure stabilizes, and weight gain occurs.

In the secondary form of adrenal insufficiency, only glucocorticoids are used, without the use of aldosterone drugs. In case of stressful effects (trauma, surgery, infection), the dosage of hormonal drugs is increased.

One of the components of complex treatment of hypocortisolism should be diet. Basic principles of nutrition:

enriching the diet with proteins;
high calorie foods;
increasing the intake of vitamins C and B;
increasing the amount of salt;
limiting foods containing potassium.

For accompanying symptoms (gastrointestinal disorders, cardiac dysfunction), symptomatic treatment is carried out. In the presence of tumor formations in the adrenal glands, the hypothalamic-pituitary system, surgical intervention is performed. Adequate treatment allows women with hypocortisolism to improve their quality of life and avoid complications associated with adrenal hormone deficiency.

Learn about the symptoms of left adrenal hyperplasia and methods of treating the pathology.

What the hormone cortisol is responsible for in men and the normal levels of the anti-stress regulator is written on this page.

Go to the address and read about what hormones the pituitary gland produces and why the body needs them.

To reduce the risk of developing chronic adrenal hormone deficiency, women are advised to:

avoid emotional and physical overload of the body;
eliminate alcohol consumption;
take hormonal and psychotropic drugs only as prescribed by a doctor, strictly observing their dosage.

Adrenal insufficiency in women is a serious pathological condition that requires timely diagnosis and treatment. A deficiency in the synthesis of hormones by the adrenal glands is fraught with irreversible changes for the body and can cause Addisonian crisis and even death. You cannot ignore the first signs that may indicate adrenal dysfunction; it is important to seek medical help in a timely manner.

A specialist from the Moscow Doctor clinics will give more useful information about adrenal insufficiency in the following video:

The endocrine system is designed to control and regulate the functioning of the entire body. Human health depends on the quality of its functioning.

The adrenal glands belong to the endocrine system. Their pathologies can lead to serious consequences. Let's look at the symptoms of adrenal disease in this article. Treatment of this disease in women has its own characteristics.

Before dealing with the pathologies of these glands, it is necessary to find out what their role is in the body. This is a paired organ that is located behind the kidneys in the abdominal cavity. In their structure, two structures are distinguished: the medulla and the cortex. In the human body, the adrenal glands perform a number of important functions:

The cortex synthesizes the hormones corticosterone and cortisol.
Here, in the adrenal cortex, the synthesis of sex hormones occurs. They directly influence the formation of secondary sexual characteristics. If women have excessive production of such hormones, then one can observe the appearance of signs that are characteristic of men.
Hormones produced in the cortex control the water and electrolyte balance in the body.
The medulla is responsible for the synthesis of adrenaline and norepinephrine. They stimulate the work of the heart muscle, increase blood glucose levels, blood pressure, and dilate the bronchi.
All adrenal hormones stimulate the body's response to stressful situations.

The adrenal glands perform all these functions if nothing disrupts their work. But this, unfortunately, does not always happen. The work of this organ can also be disrupted, but it is important to detect adrenal diseases in women in time. Symptoms are easy to detect if you listen more carefully and take a closer look at your body.

Any disturbances in the functioning of this organ have their own manifestations; it is important to pay attention to them in time and visit an endocrinologist.

In the female body, both excess and lack of hormones lead to disruptions in the functioning of organ systems. First of all, this kind of pathology affects a woman’s ability to conceive and bear a baby. But adrenal disease in women also manifests itself with the following symptoms:

Sun intolerance, it most often manifests itself in the form of excessive tanning.
Constant depression.
Painful sensations in the chest.

The monthly cycle is disrupted.
The breasts become smaller, as does the uterus.
Acne appears on the face and other areas of the skin.
The clitoris is growing.

Even if there are only a few symptoms, a woman should immediately visit a doctor to take the necessary measures to correct the problem. That is why it is necessary to know how adrenal disease manifests itself in order to associate the existing symptoms with the pathology of this organ.

All doctors believe that problems in the functioning of this organ can result in serious complications in a woman’s health. Experts most often note the following diseases of the adrenal glands in women, the symptoms of which can be observed:

Hyperaldosteronism. With this pathology, the organs synthesize too much of the hormone aldosterone.
Insufficiency of the cortex.
Hyperplasia of the adrenal cortex.
Pheochromocytoma.
Androgenital syndrome combines several congenital abnormalities.
Adrenal tumors.
Addison's disease is much less common than other pathologies.
Itsenko-Cushing syndrome.

All these diseases have both their own causes for development and symptoms. We will consider adrenal gland diseases in women in more detail below.

This pathology comes in primary and secondary forms. Manifests itself in increased production of aldosterone by the adrenal cortex. Doctors identify the following reasons for the development of this condition:

Liver diseases, such as cirrhosis.
Chronic inflammatory processes in the kidneys.
Heart failure.
The secondary form occurs if the primary one was not completely cured.

Hyperaldosteronism is manifested by the following symptoms:

General and muscle weakness appears.
Frequent headaches.
Increased fatigue.

Attacks of rapid heartbeat occur.
Too much urine is produced per day.
A person has a constant thirst.
If you do a blood test, it shows a decrease in calcium.
Feeling of numbness in some parts of the body.
Frequent seizures.

As soon as symptoms characteristic of a condition such as adrenal disease occur, treatment in women should begin immediately. The first step is to eliminate the pathology that caused the development of the disease.

As a rule, this pathology is accompanied by other painful conditions in the body. The reason for this is considered:

Damage to the anterior pituitary gland.
Necrosis of the pituitary gland.
Tumors.
Infectious diseases.

Cortical deficiency is manifested by the following symptoms:

Asthenia develops.
The patient feels a sharp loss of strength.
Body weight begins to decrease sharply.
Lost appetite.
Nausea and vomiting.
Pigment spots appear on the skin.
There is a decrease in blood pressure that is not amenable to drug therapy.
Stool disorders.
Copious urine output at night.
Blood glucose levels decrease.

If adrenal disease clearly manifests its symptoms, treatment is prescribed in the form of glucocorticoids and mineralocorticoids.

Typically, this pathology is congenital and is accompanied by a clear disturbance in the production of cortisol. Experts call this cause of the painful condition: a genetic mutation. Anything can provoke it.

This pathology manifests itself as follows:

Severe hyperpigmentation of the external genitalia appears.
Virilization.
Hair in the armpit and pubic area begins to grow too early.
Acne on the skin.
Girls start menstruation late.

With such a pathology, early diagnosis is important so that it is possible to take appropriate measures for the normal functioning of the body.

Most often, tumors of this organ are benign. The exact causes have not yet been established, but for a hormonally active tumor, which is also called pheochromocytoma, the following provoking factors are called:

Thyroid oncology.
Systemic pathologies with congenital anomalies of cerebral vessels, skin, and eye membranes.
Excessive synthesis of hormones by the parathyroid glands.

With this pathology, the following symptoms of adrenal gland disease in women can be observed (the photo shows one of them):

High blood pressure.
The heart rhythm is disturbed.
Muscle weakness appears.
Frequent urge to go to the toilet at night.
Nausea and vomiting become frequent companions of a person.
Increased sweating.
Cramps.
The patient's appearance deteriorates.
Constant shaking and chills.
Dry mouth.

Depending on the symptoms of adrenal disease in women, therapy is prescribed.

With this pathology, the adrenal glands stop producing sufficient amounts of cortisol. The following conditions are considered to be the causes:

Damage to the endocrine glands by tuberculosis.
Disturbances resulting from exposure to chemicals.
Adrenal insufficiency.
Autoimmune processes.

Signs of this disease overlap with other pathologies:

The heart begins to beat faster.
Nausea and vomiting appear.
Blood pressure drops.
Abnormal stool.
A sharp decrease in body weight.
Fatigue sets in quickly.
Memory and attention suffer.
Hair loss occurs in the axillary and pubic areas.
Sexual desire decreases.

Most often, this pathology is detected when various neoplasms appear in the adrenal glands or neighboring organs. Symptoms of this disease include the following:

Women develop male-type obesity.
Atrophy and weakness appear in the muscles.
Permanent depression.
Frequent headaches.
The capillaries become fragile, causing bruises to appear on the body.
Furunculosis.

Whatever pathology develops, early diagnosis of adrenal diseases is very important.

To recognize diseases of these organs, doctors have a whole arsenal of methods. If signs of adrenal gland disease appear in women, “How to check for pathology?” - first question. When visiting an endocrinologist, a woman will be asked to undergo the following types of studies:

Donate blood and urine for analysis.
Undergo magnetic tomography.
Computed tomography will also not be superfluous.
Take an X-ray of the skull to determine the size of the pituitary gland.
Take hormonal tests.
An x-ray of the skeletal system will determine the presence of osteoporosis.
A modern diagnostic method is radiation examination, which makes it possible to obtain information about the condition and functioning of the adrenal glands.

We have studied adrenal diseases in women in detail. Symptoms and diagnosis of these pathologies are discussed in the article. It remains to investigate the treatment of diseases of this organ.

The task that doctors face when a pathology of the adrenal glands is detected is to restore normal hormone levels. In addition, it is necessary to neutralize all factors that aggravate the course of the disease. Patients are recommended:

Taking hormonal medications, but strictly under the supervision of a doctor and according to the prescribed regimen and dosage. Such therapy is prescribed only after a complete examination.
Antiviral and antibacterial drugs are often prescribed.
Taking vitamins and minerals is beneficial.
It is very important to pay attention to your diet.
Lead a healthy lifestyle, spend more time in the fresh air and move.
Try to avoid stressful situations.

Surgery is resorted to only in extreme cases when hormonal therapy has not brought the desired results. Taking into account the characteristics of the pathology, one or both adrenal glands may be removed. Surgeons use two approaches:

Traditional. Abdominal surgery is performed, a small incision is made, if the tumor is small - on the back, in the lumbar region. For large tumors, a large incision must be made in the abdomen.
The endoscopic approach involves surgery using endoscopes that are inserted through a small hole in the abdomen or back. This method has its advantages:

The patient can go home after a few days.
Minimal injury.
Working capacity is restored in 2-3 weeks.
There are no scars left after surgery.
Bed rest - just one day.

If one adrenal gland is removed, then most often you can forget about the symptoms of the pathology, but if both are ectomized, you will have to take hormonal medications for the rest of your life.

Endocrine glands are very important in the normal functioning of our body. Any of their pathologies must necessarily undergo adequate therapy under the supervision of a competent specialist. This is the only way to ensure the normal functioning of all organ systems.

Symptoms of adrenal insufficiency or hypocorticism– endocrine disease, appear predominantly in men and women over 20 years of age.

Progressive decline in adrenal function causes severe hormonal deficiency. When a number of important hormones produced by the adrenal glands are insufficient, the body experiences disruptions in the functioning of many organs.

Adrenal dysfunction causes the body to lack certain hormones. They answer for the quality of metabolic processes and the activities of internal systems.

Hormones produced by the adrenal glands:

Mineralocorticosteroids or mineralocorticoids. Regulates the body's water-salt balance and mineral metabolic processes.
Glucocorticosteroids. Responsible for the absorption and breakdown of carbohydrates, reduce inflammatory processes.
Adrenalin. A hormone produced during moments of stress and physical activity.
A small amount of androgens. They improve protein synthesis, while increasing the overall muscle mass of the body, and help regulate the fat balance in the body. The function is also important during puberty during the formation of secondary male sexual characteristics.

Depending on the time and duration of the disease, it can have an acute and chronic form. The acute form develops rapidly and may be fatal, for this reason, treatment is carried out urgently. Characterized by hemorrhage into the adrenal cortex.

A chronic disease can last for years and, with adequately selected therapy, does not threaten fatal consequences for a long time.

Under unfavorable conditions, such as stress, trauma and others, the chronic course can progress to the acute stage.

There are also three main types of the disease:

Primary deficiency. The most common type of disease, which affects the cortex and body of the adrenal gland.
The deficiency is secondary. Occurs when the function of the pituitary gland of the brain (pituitary gland) is damaged.
Tertiary deficiency. Develops when the hypothalamus malfunctions.

There is another type of hypocortisolism - drug or iatrogenic. Evolving in the background abrupt withdrawal of hormonal medications. An extremely rare form of the disease.

Each form of hypocortisolism has its own factors that cause it, they can overlap with each other. Causes of primary form of deficiency:

Pathology of the cortex and the organ itself, developing in utero, is congenital.
The autoimmune origin of the disease is associated with disorders of other organs of the endocrine system. This is the main cause of hypocortisolism. With this pathology, the adrenal glands' own protective antibodies attack their tissues. In up to 50% of cases, this is associated with diseases of the thyroid gland, in particular thyroiditis.
Pulmonary tuberculosis in a widespread form, affecting other organs.
Genetic disorder - adrenoleukodystrophy. Associated with a lack of enzymes that break down lipids (fats). In this case, unprocessed fatty acids accumulate in the tissues of the adrenal glands and cause pathological abnormalities in their work.
The cause may also be oncological diseases and their metastases.
Trauma and surgical procedures.
Necrotic changes in tissues associated with infectious diseases of the genital organs, HIV, syphilis, etc.
Taking medications that have side effects that damage the adrenal glands.
Aggravating factors may include diseases of the cardiovascular system and fungal diseases.

(The picture is clickable, click to enlarge)

Causes secondary and tertiary forms:

Hypocortisolism can develop as a complication after infectious diseases.
Congenital pathologies of brain regions. Dysfunction of the hypothalamus and pituitary gland.
Injury to adrenal tissue, for example, rupture of the organ. Other causes may include surgery or radiation therapy.
Autoimmune brain disorders.
Benign and malignant neoplasms in the hypothalamus and pituitary gland. Hemorrhages in these areas.
Long-term use of drugs that inhibit the functions of brain and adrenal activity.

The dynamics of the disease and its symptoms depend on the speed of development of pathology. Thus, the symptoms of chronic hypocortisolism may not appear for many years.

Congenital pathology is detected by external signs within several months after birth.

The chronic form is accompanied by the following symptoms:

General weakness and fatigue.
Depressed muscle strength, aching pain in the body.
Skin hyperpigmentation.
Skin hypopigmentation. Certain areas of the skin lose color intensity, and vitiligo develops - a complete lack of pigmentation in these areas.
Problems with the gastrointestinal tract.
Many patients may experience hypoglycemia, a sharp drop in blood sugar levels.
Low blood pressure is characteristic from the very beginning of the disease.

Attention! Long-term preservation of intense skin color after tanning is one of the signs of hypocortisolism.

The acute form of the disease has almost all the same symptoms as the chronic form, but in a more pronounced form. They usually develop rapidly during few hours.

Besides:

Sharp and severe hypotension. Sweating, weakness and chills.
Acute disorder of the gastrointestinal tract. Bloating, diarrhea, sharp abdominal pain.
Fainting and dizziness, loss of orientation and hallucinations.

The main and dangerous complication of adrenal insufficiency is Addisonian crisis. Its development causes precomatose and comatose states.

Signs of a crisis:

Lethargy of the patient, to the point of complete loss of ability to move.
A drop in blood pressure, up to loss of consciousness.
Constant and incessant vomiting and loose stools. Sometimes bloody impurities are observed.
Dehydration, and as a sign, the smell of acetone from the mouth.
Impaired cardiovascular activity, acute heart failure.
Nervous system disorders - seizures, delirium.
Severe hyperpigmentation of the skin.

Adrenal crisis is difficult to treat with medication and regularly leads to death. The patient must be hospitalized immediately.

If the patient is in a sane state, diagnosis begins with collecting an anamnesis and explaining the symptoms to the patient himself. A survey is conducted to determine the presence of diseases related to hypocortisolism. In addition, the main manipulations for making a diagnosis:

measurement of blood pressure, in a patient with insufficiency it is low;
the skin is examined for the presence of pigmentation, its nature and intensity;
the patient's pulse is measured, it is usually rapid;
ECG, which additionally confirms arrhythmic heart contractions;
blood tests are prescribed, which reveal an increased erythrocyte sedimentation rate (ESR), lymphocytosis, decreased sugar levels, etc.;
urine analysis, which reveals high levels of acetone during dehydration;
analysis of the level of hormones produced by the adrenal glands;
ACTH test;
ultrasound diagnostics and x-rays. To identify foci of inflammation;
computed tomography of the adrenal glands (CT);
MRI of the brain to identify pathologies of the hypothalamus and pituitary gland.

The acute form of hypocortisolism requires in hospital treatment. During a crisis, the patient is placed in the intensive care unit and intensive care wards. When choosing the type of treatment, the factors that caused the disease are taken into account.

To eliminate the causes of deficiency, drugs are prescribed against the primary disease.

Treatment methods:

Complete elimination of the root cause of the disease. Medicines are used, radiation therapy, and surgery are performed.
Hormonal therapy. Hydrocortisone, Prednisolone, and glucocorticoids are administered.
Elimination of dehydration by administering saline solution with glucose.
To eliminate hypoglycemia and restore water-salt balance, drugs with sodium chloride and glucose in combination are also administered. Be sure to select the correct dosage. Since an excess of sodium with a glucocorticoid can cause hemorrhage in the brain and pulmonary edema.
Changes in blood parameters and sodium content in the blood are monitored.
For chronic insufficiency, treatment in courses is indicated, up to 3 times a year, with additional anabolic steroids prescribed.
Maintaining a diet rich in vitamins and minerals, eliminating bad habits.

Treatment of children with hypocortisolism is primarily carried out in a hospital setting. For congenital forms, mineralocorticoids are necessarily prescribed, which makes it possible for the child’s body to develop normally.

Glucocorticoids are prescribed with caution, due to the fact that they have a negative effect on the growth of the child. The safest drug in this regard is Hydrocortisone.

It is specially added to the food of infants up to 1 teaspoon salt daily. In general, constant therapeutic measures lead to normalization of the child’s life and activities.

Since the disease is dangerous due to its crisis, a bracelet is put on the child’s hand indicating the disease and the medications he is taking.

With proper and timely treatment, the disease has a favorable prognosis for both adults and children. Also, properly selected therapy reduces the risk of a crisis, which has unfavorable outcomes, to a minimum.

What to do, which doctor to contact for this disease:

Treatment of chronic adrenal insufficiency is aimed, on the one hand, at eliminating the process that caused damage to the adrenal glands and, on the other, at replacing the lack of hormones.

If a tuberculosis process in the adrenal glands is suspected, it is necessary to prescribe anti-tuberculosis drugs in courses under the supervision of a phthisiatrician. Patients with autoimmune damage to the adrenal glands are treated with levomisol and thymosin, aimed at normalizing the deficiency of T-suppressors. Currently it is not widely used.

Replacement therapy with synthetic hormones that have glucocorticoid, mineralocorticoid and anabolic effects is vital for patients with chronic adrenal insufficiency and cannot be canceled under any conditions. Compensation for adrenal insufficiency depends not only on the amount of the drug administered, but also on various conditions related to the functional state of the body. Synthetic analogues of hormones do not behave quite the same way in the body as natural ones. For example, it is known that the specific protein transcortin binds about 92% of cortisol and only 70% of its synthetic analogues. It is believed that the absorption of hormones in the gastrointestinal tract is almost complete, but with various disorders of the stomach and intestines, these conditions may be disrupted. For oral administration, synthetic analogues of glucocorticoid action are used: hydrocortisone, cortisone acetate, prednisolone, prednisone, metypred. Hydrocortisone is the only glucocorticoid that has the properties of a natural hormone. Currently, it is registered in Russia under the name Cortef, used in tablets of 5, 10 and 20 mg.

Treatment with cortisone began in the 30s of our century and, despite the emergence of many new analogues, has not lost its importance to the present day. Cortisone in the liver is mainly converted into cortisol and becomes physiologically active. The highest concentration of the drug in the blood is determined 1-2 hours after administration, and after 8-10 hours it is almost undetectable. 9a-fluorocortisol is more effective than cortisone - already 30 minutes after administration, its level in the blood increases significantly, reaching a maximum after 6-8 hours. Prednisolone is contained in the blood for 12-36 hours, and hydrocortisone administered intramuscularly - 4- 6 hours. To compensate for chronic adrenal insufficiency, it is necessary to use a combination of prednisolone and cortisone. The dose of drugs depends on the severity of the disease and the degree of compensation.

For mild chronic adrenal insufficiency, it is recommended to treat with cortisone at a dose of 12.5-25 mg/day in one or two doses. If the dose is taken once, then in the morning after breakfast. Treatment can be combined with the administration of ascorbic acid 1-1.5 g/day with meals.

For moderate severity of the disease, prednisolone is usually prescribed - 5-7.5 mg after breakfast, and in the afternoon - 25 mg of cortisone acetate.

Patients with severe chronic adrenal insufficiency, which is observed both in Addison's disease and after removal of the adrenal glands for Itsenko-Cushing's disease and other diseases, sometimes have to prescribe glucocorticoids in three doses and must combine them with DOXA drugs. For example, prednisolone is recommended in a dose of 5-7.5 mg in combination with 1 tablet of DOXA under the tongue after breakfast, cortisone in doses of 25 mg after lunch and 12.5 mg after dinner. If you have low blood pressure and poor appetite, you can add 1 DOX tablet to your prescription every day. It is believed that the given doses, although considered schematic, should compensate for adrenal insufficiency, unless there are any reasons requiring their increase. Objective indicative effects of glucocorticoids include an increase in body weight, cessation of nausea and gastrointestinal disorders, a decrease in pigmentation of the skin and mucous membranes, and improvement or restoration of water tolerance.

Radioimmunological determination of ACTH, cortisol, aldosterone and renin activity in plasma is considered uninformative for the systematic assessment of the effectiveness of replacement therapy for Addison's disease.

In moderate and severe forms of chronic adrenal insufficiency in most patients with Addison's disease and in all after removal of the adrenal glands, it is necessary to add drugs with a mineralocorticoid effect to the drugs with glucocorticoid action. The daily requirement for deoxycorticosterone acetate is 5-10 mg. DOXA preparations are available in various forms for oral and intramuscular administration. DOXA 5 mg tablets are used sublingually. 0.5% oil solution of DOXA is applied 1 ml intramuscularly. The prolonged drug deoxycorticosterone trimethyl acetate is prescribed intramuscularly, 1 ml once every 10-12 days. The most active synthetic mineralocorticoid is fludrocortisone acetate. In Poland it is produced under the name cortinef, and in the UK it is called florinef. The drug in a dose of 0.05-0.1 mg is used as a maintenance drug. During the period of decompensation of the disease, its dose increases 2-3 times. Objective indicators of the action of mineralocorticoids include an increase in blood pressure, normalization of the sodium/potassium ratio, an increase in plasma sodium levels and a decrease in potassium levels.

There are several important conditions for replacement therapy for chronic adrenal insufficiency. The dose and time of administration of drugs should be prescribed taking into account the production and daily rhythm of corticosteroid release in a healthy person: 2/3 of the daily dose is administered from 7-9 a.m. and % in the afternoon; medications are always prescribed after meals. Use of corticosteroids over the years can lead to gastrointestinal disturbances; in case of stress, infections, operations, injuries, the dose of gluco- and mineralocorticoids is increased by 2-3 times compared to the maintenance dose.

In case of gastrointestinal disorders in patients with chronic adrenal insufficiency, oral medications are replaced by parenteral administration of hydrocortisone 50-100 mg 4-6 times a day and DOXA - 5-15 mg to compensate for the condition.

It is necessary to dwell on the features of patient management after removal of the adrenal glands for Itsenko-Cushing's disease. After removal of one adrenal gland, hormonal therapy is not prescribed, since the remaining adrenal gland compensates for the body's need for hormones. After removal of the second adrenal gland (stage II), immediately on day 1, patients receive 75-100 mg of water-soluble hydrocortisone intravenously. At the same time, intramuscular injections of hydrocortisone are prescribed according to the following scheme: days 1-2 - 50-75 mg every 3 hours, day 3 - 50 mg every 4-5 hours, days 4-5 - 50 mg every 5 hours, Days 6-7 - 50 mg every 8 hours, days 9-10 - 50 mg 2 times a day. As a rule, from the 8th-9th day, patients are gradually transferred to oral corticosteroids, and a fixed dose of drugs is established during observation. Prednisolone is prescribed at 5-15 mg/day, or 5 mg of the drug in the morning with 1 tablet of DOXA, or 1 tablet of Cortinef and 25 mg of cortisone in the afternoon. If hypertension persists in patients after removal of the adrenal glands, the dose of replacement therapy is prescribed the same as without hypertension, and DOXA drugs are also used. Hormone replacement therapy is combined with antihypertensive drugs, preference is given to rauwolfia preparations. It should be noted that Addisonian crisis in patients with adrenal insufficiency and hypertension can occur against a background of high blood pressure. Under these conditions, patients need to undergo therapy aimed at eliminating the Addisonian crisis.

After minor surgical interventions, patients with chronic adrenal insufficiency (opening of abscesses, biopsies, tooth extractions) on the 1st day are administered intramuscularly 3 times 50 mg of hydrocortisone, on the 2-3rd day - 50 mg 2 times, and from the 3rd On the 4th day the patient is transferred to the usual dose of corticosteroid drugs in tablets.

When patients with chronic adrenal insufficiency undergo planned surgical interventions on the eve of the operation, hydrocortisone 50 mg is prescribed intramuscularly every 8 hours. On the day of the operation, 75 mg of hydrocortisone is administered intramuscularly, and during the operation - 75-100 mg of water-soluble hydrocortisone in saline is administered intravenously. or 5% glucose solution. On days 1-2 after surgery, hydrocortisone is administered intramuscularly at 50-75 mg every 6 hours. On days 3-4 - 50 mg every 8 hours, and on days 5-6 - 50 mg 2 times per day and prednisolone 5-10 mg per day is administered orally. On the 7th day, 50 mg of hydrocortisone and 5 mg of prednisolone 2-3 times a day are administered intramuscularly. From the 8th day, patients are transferred to conventional oral replacement therapy with corticosteroids according to a fixed dose, individual for each patient. In addition, during the first 3-4 days, patients receive 5-10 mg of DOXA as a single intramuscular injection. In the postoperative period, careful monitoring of the patient's condition is necessary. To do this, you should measure your blood pressure every hour. In case of signs of adrenal insufficiency, urgently begin additional intravenous administration of water-soluble hydrocortisone at the rate of 75 mg per 1-1.5 hours. The amount of hormones administered should be large, and the duration of their use may vary depending on the patient’s condition, the severity of the surgical intervention, and complications .

In case of emergency surgery, immediately before the operation, 75-100 ml of hydrocortisone is administered intramuscularly, subsequently according to the given scheme.

When treating chronic adrenal insufficiency, symptoms of overdose of both gluco- and mineralocorticoid drugs may occur. This is evidenced by rapid weight gain, headaches, muscle weakness, increased blood pressure, fluid retention, facial swelling, decreased plasma potassium levels and increased sodium levels. The dose of administered drugs should be reduced by at least 2 times. Elimination of overdose symptoms occurs slowly over 4-8 weeks. The maintenance dose should be reduced after the elimination of drug-induced hypercortisolism.

This phenomenon often occurs when glucocorticosteroids are prescribed in high doses. Adding DOXA to therapy allows you to reduce the dose of glucocorticoid hormones and obtain compensation for adrenal insufficiency.

In conclusion, it is necessary to consider the features of replacement therapy in patients with chronic adrenal insufficiency during pregnancy, when combined with diabetes mellitus, diseases of the thyroid and parathyroid glands. The dose of replacement therapy during pregnancy remains the same, a slight increase is required after the 3rd month. All patients are hospitalized before giving birth. During childbirth, hormones are administered under the same conditions as during planned operations. When chronic adrenal insufficiency and diabetes mellitus are combined, it is recommended to first compensate for adrenal insufficiency and then increase the dose of insulin. In patients with a combination of chronic adrenal insufficiency and hypothyroidism or thyrotoxicosis, full compensation of adrenal insufficiency is first achieved, and then either thyroxine or antithyroid therapy is added. The same conditions are met in the presence of hypoparathyroidism. Patients with chronic adrenal insufficiency should be monitored and provided with free corticosteroid drugs.

Adrenal insufficiency or hypocorticism is a dangerous dysfunction of the endocrine system, which leads to a decrease in the synthesis of glucocorticoids and mineralocorticoids, hormones of the cortical layer of the gland.

The disease provokes metabolic disorders, in particular, water-salt metabolism.

Manifestations of this disease, if untreated, can lead to irreversible consequences, in particular the development of coma or clinical death.

Cortical dysfunction can be of 2 types:

sharp;
chronic.

Chronic adrenal insufficiency also has 2 forms:

primary;
secondary.

Primary adrenal insufficiency is called Addison's disease or hypocortisolism syndrome and occurs due to damage to the cortex of the endocrine glands.

In turn, secondary adrenal insufficiency is a manifestation of disturbances in the functioning of the pituitary gland, in which it decreases.

Causes of chronic manifestations of the disease

Factors that cause primary hypocortisolism may be:

infectious diseases;
immunity disorders;
metastases of oncological tumors;
during long-term use of hormonal drugs.

The secondary form of the disease develops when there are disturbances in the functioning of the brain.
The reasons are:

neoplasms in the pituitary gland;
head injuries;
surgical intervention in the brain area;
treatment with radioactive rays;
severe drug or alcohol intoxication;
hypopituitarism.

In more than half of the cases, the causes of primary hypocortisolism are not diagnosed. Most often, this pathology manifests itself in females and often in adolescents.

All cases of the disease in children are taken under special control.

Symptoms of hypocortisolism

Chronic adrenal insufficiency has a number of characteristic symptoms:

Decreased muscle tone that progresses over time.
Weight loss due to loss of desire to eat.
A change in pigmentation towards its increase, in particular in visible areas of the body and, especially, in places of rubbing with clothing.
The appearance of characteristic dark or white spots on the affected skin.
Hypotension, often causing fainting.
Increased desire to eat salty foods.
Decreased intellectual abilities and worsening mood.

Secondary adrenal insufficiency manifests itself with the same symptoms, but unlike the primary type, it does not cause a strong change in pigmentation.

When the pituitary gland is damaged, only cortisol synthesis is disrupted, so all symptoms are less pronounced.

Primary adrenal insufficiency and primary hypocortisolism manifests itself in women as hair loss in the pubic or armpit areas.

Signs of adrenal insufficiency develop only after 90% of all gland tissue has been destroyed.

Acute failure and its causes

Acute adrenal insufficiency is a coma that occurs as a result of a crisis of Addison's disease.
It can develop under the following conditions:

How a complication occurs in the chronic form of the disease.
If you suddenly stop taking hormones.
Due to autoimmune thyroiditis.

Acute adrenal insufficiency in children can be triggered by difficult childbirth and the occurrence of microstrokes in the adrenal parenchyma.

Other provoking factors of a non-pathological nature may be:

blunt abdominal trauma;
taking a large number of anticoagulants;
abdominal surgery;
blood poisoning;
inflammation of appendicitis;
severe form of burn injury or frostbite.

A decrease in synthesis leads to the body no longer adapting to stress.

Acute symptoms

Manifested by specific symptoms:

the occurrence of prostration;
loss of consciousness due to a sharp decrease in pressure;
severe vomiting;
diarrhea, which leads to a complete disruption of the body’s water-salt metabolism;
the appearance of a characteristic sign - the smell of acetone;
convulsive conditions;
the occurrence of heart failure.

The skin may suddenly darken.

The crisis state of hypocortisolism syndrome can have three forms of clinical manifestation:

Disturbances in cardiovascular activity;
Gastrointestinal disorders;
Mental disorders.

Any manifestation of a crisis can occur spontaneously and is difficult to treat. Failure to provide assistance results in death.

In the chronic course of the disease, it is important to constantly maintain correct hormonal therapy so that a crisis does not arise.

Symptoms of cardiovascular disease

If the acute form is manifested by signs of impaired cardiovascular function, the patient will have the following symptoms:

paleness of all integuments;
acrocyanosis;
hands and feet become cold to the touch;
heart rhythm disturbance;
decreased blood pressure;
disappearance of pulse.

With cardiac disorders, urinary retention may occur.

Gastrointestinal form of manifestations

Symptoms of gastrointestinal disorders are as follows:

spasms in the stomach and intestines;
vomiting and nausea;
diarrhea, often bloody;
unstoppable flatulence.

Such signs resemble the condition of an acute abdomen and can be confused with poisoning. Only test results will indicate clinical differences.

Neuropsychic form of disorder

This type of pathology manifests itself:

migraines;
meningeal symptoms;
delusional;
state of stupor;
lethargy.

In this case, acute adrenal insufficiency consists of three phases of development:

Initially, weakness and skin pigmentation increase, and nausea appears.
With the prolonged development of the pathology, the symptoms intensify, leading the person to an incapacitated state.
The manifestation of the last stage is the incapacitated state of the patient’s body.

Coma is the final stage of an acute state of adrenal insufficiency. It requires immediate hospitalization of the patient and provision of resuscitation care.

Carrying out diagnostic activities

Diagnosis of adrenal insufficiency is carried out in several ways:

Carrying out blood screening, which reveals a reduced amount of hemoglobin and an increased amount of eosinophilic bodies.
Conducting a urine test to determine low levels of adrenal hormones.
Use of computed tomography for suspected severe kidney infections.
If primary hypocortisolism is suspected, endocrinologists perform special tests, including tests for autoimmune antibodies.
Fine needle biopsy of adrenal cortex tissue.

The initial appointment with an endocrinologist begins with collecting information about the patient’s condition, as well as examining his body.

To confirm the diagnosis of a secondary form of hypocortisolism, an MRI of the brain is also performed.

Treatment of the disease

Acute insufficiency of the adrenal cortex and l Acute adrenal insufficiency is treated using the following methods:

Use an isotonic chloride solution in a batch of 2 liters per day.
Use a glucose solution.
Prednisolone is administered intravenously, gradually reducing its concentration until the patient’s condition stabilizes.
In the presence of an infectious provoking agent, antibacterial therapy is started.

For concomitant signs of adrenal insufficiency that are related to gastrointestinal or cardiac disorders, symptomatic treatment is used.

Treatment of chronic failure

During the chronic form of the disease, the following therapy is carried out:

eliminate the original cause of glandular insufficiency;
replace the necessary ones;
corrects the functioning of affected body systems;
use vitamin-mineral and enzyme complexes to strengthen the immune system.

To eliminate the causes of endocrine gland insufficiency, the following medications and methods of therapy are used:

antibiotics;
antimycotics;
anticancer therapy;
the use of surgery to remove tumors.

Treatment of the primary form of chronic failure is carried out using hormone replacement therapy.
In this case, the following drugs may be prescribed:

Cortisone;
Cortef;
Prednisolone;
Didn't work;
Retabolil.

Treatment is considered effective if the manifestations of the disease disappear and the indicators of the body systems return to normal.

Prevention

To carry out preventive measures for adrenal insufficiency, the following tips are used:

do not overload the body;
do not drink alcoholic beverages;
do not abuse psychotropic drugs;
When taking hormonal therapy, you cannot change it yourself.

If you follow all preventive measures and regularly use medications prescribed by a specialist, you can achieve a positive effect.

Women of childbearing age who are being treated for chronic insufficiency are able to conceive normally and give birth to a healthy baby.

Diet

If adrenal gland function is insufficient, a special diet is prescribed.
It is based on the following principles:

an increase in protein foods in the diet;
increasing calorie intake;
using foods rich in vitamins B and C;
enriching the diet with salty foods.

Interesting!

The use of the special drug Sanasol helps saturate the body with potassium and sodium chloride. Its use has contraindications in the form of renal failure.

Prognosis of the course of the disease

A favorable treatment outcome depends on timely prevention of crises and regular use of hormonal therapy.

In this case, it is necessary to take into account the conditions for recovery from infectious diseases that provoked the development of adrenal insufficiency.

A condition in which the body experiences an acute shortage of steroid hormones is called adrenal insufficiency. Hormones are produced directly in the adrenal cortex, and the disease can be either acute or chronic. The disease causes a malfunction in the water-electrolyte balance and disruption of the cardiovascular system. A person who knows the symptoms of hypofunction of the adrenal cortex can consult a specialist in a timely manner, which will increase the chances of an easy course of the pathology.

Adrenal dysfunction can arise from direct pathology of the organ itself or due to problems with the pituitary gland.

Classification

Classifies adrenal insufficiency based on two criteria:

localization of deficiency;
course of failure.

Depending on the location, adrenal hypofunction is divided into 3 groups:

Primary. It is characterized by the fact that the adrenal glands are directly affected. Primary insufficient concentration of hormones is much more complicated than secondary and tertiary.
Secondary. Caused by pathology of the pituitary gland, which produces adrenocorticotropic hormone in small quantities or not at all. This hormone affects the functioning of the adrenal glands.
Tertiary. It is characterized by the fact that the hypothalamus produces a small amount of corticoliberin.

Depending on the course, adrenal insufficiency is divided into 2 groups:

Spicy. It is characterized by the development of a serious condition of the patient, which is also called Addisonian crisis. It can be fatal, therefore, it is important for a patient who notices the first symptoms to immediately seek help from a specialist.
Chronic. It has 3 stages: subcompensation, compensation, decompensation. Unlike acute insufficiency, it does not have such severe consequences and, with competent and timely therapy, can be observed for many years in a mild form.

Causes and mechanism of development of adrenal insufficiency

Considering that the adrenal glands are a paired organ, the occurrence of symptoms of a chronic disease is possible only after more than 90% of their cortex has been injured. Primary failure is observed in cases of damage directly to the adrenal glands, caused by the following conditions:

congenital pathology of the adrenal cortex;
tuberculosis;
Algrove syndrome;
blood clots in the vessels that supply the organ;
accumulation in the tissues of the organ of increased concentration of protein, which manifests itself during a prolonged course of the acute form of the disease;
cancer tumors whose metastases have affected the adrenal glands;
severe diphtheria;
cancerous formations in the organ;
adrenal necrosis due to HIV;
sepsis;
Smith-Opitz syndrome, which is characterized by the parallel existence of several anomalies, such as a small volume of the skull, disruptions in the structure of the reproductive system and delays in the development and activity of the brain.

Adrenal insufficiency can be congenital or develop against the background of diseases of other organs and systems.

Secondary adrenal insufficiency develops due to the following pathologies of the pituitary gland:

infectious (often viral);
hemorrhage, which is caused by various types of damage;
cancerous tumors;
disruption of organ function that began after chemotherapy and surgery;
damage to the pituitary gland by its own antibodies.

Tertiary hypofunction of the adrenal cortex is formed due to:

congenital anomaly of the hypothalamus;
acquired anomalies of the hypothalamus (neoplasms and various infections).

Symptoms of adrenal insufficiency

The chronic form of damage to adrenal hormones has many symptoms, among which the most common are:

unreasonable fatigue and loss of strength;
muscle weakness;
sudden weight loss;
lack of appetite;
pain in the abdomen;
indigestion;
diarrhea;
constipation;
dizziness;
fainting;
low pressure.

The most accurate and accurate symptoms of dysfunction of the adrenal cortex are considered to be a sharp desire for excessively salty foods and darkening of the skin and mucous membranes. They become a shade of bronze, and this is best seen at the site of skin folds and scars. However, a change in skin color occurs only when adrenal insufficiency occurs in the primary form.

Acute damage to the adrenal cortex can be life-threatening for the patient. During it, the symptoms of the chronic course of the disease increase and patients feel:

prolonged low blood pressure;
gagging;
convulsions;
muscle pain;
changes in consciousness.

Diagnosis of adrenal hypofunction

Adrenal insufficiency can be determined by interviewing the patient for complaints and symptoms of the disease. However, this does not give a complete picture, and in order to identify what specific deficiency is inherent in a given case, the patient will need to visit an endocrinologist, who will prescribe an examination containing the following studies:

Ultrasound examination of the adrenal glands. There are cases when ultrasound does not give the expected result, then they resort to computed tomography of the organ.
Magnetic resonance imaging, during which special attention is paid to examining the hypothalamus and pituitary gland.

Then the patient is prescribed laboratory tests, which are effective in cases of deficiency of certain hormones. Doctors study:

The amount of cortisol in the blood. In all types of adrenal insufficiency, the concentration of the hormone is reduced.
17-OX and 17-KS in urine, which is collected during the day. A reduced concentration is diagnosed in secondary and primary failure.
Adrenocorticotropic hormone in the blood. The concentration of the hormone is high in case of adrenal disease and low in case of secondary and tertiary hypofunction.
Aldosterone level.

After the diagnosis has been established, experts study how severe disruptions have occurred in the body's metabolic processes, such as protein, carbohydrate and electrolyte. A venous blood test will help identify this, which will show the amount of potassium, calcium, sodium, glucose and protein. In addition, doctors always prescribe an electrocardiogram, which shows the state of the cardiovascular system and how the heart reacts to disturbances in the electrolyte balance.

– a disease that occurs as a result of insufficient hormonal secretion of the adrenal cortex (primary) or the hypothalamic-pituitary system regulating them (secondary adrenal insufficiency). It manifests itself as a characteristic bronze pigmentation of the skin and mucous membranes, severe weakness, vomiting, diarrhea, and a tendency to faint. Leads to disorders of water-electrolyte metabolism and cardiac dysfunction. Treatment of adrenal insufficiency includes eliminating its causes, replacement therapy with corticosteroid drugs, and symptomatic therapy.

General information

– a disease that occurs as a result of insufficient hormonal secretion of the adrenal cortex (primary) or the hypothalamic-pituitary system regulating them (secondary adrenal insufficiency). It manifests itself as a characteristic bronze pigmentation of the skin and mucous membranes, severe weakness, vomiting, diarrhea, and a tendency to faint. Leads to disorders of water-electrolyte metabolism and cardiac dysfunction. The extreme manifestation of adrenal insufficiency is adrenal crisis.

The adrenal cortex produces glucocorticosteroid (cortisol and corticosterone) and mineralocorticoid (aldosterone) hormones that regulate the main types of metabolism in tissues (protein, carbohydrate, water-salt) and the body's adaptation processes. Secretory regulation of the activity of the adrenal cortex is carried out by the pituitary gland and hypothalamus through the secretion of the hormones ACTH and corticoliberin.

Adrenal insufficiency combines various etiological and pathogenetic variants of hypocorticism - a condition that develops as a result of hypofunction of the adrenal cortex and a deficiency of the hormones it produces.

Classification of adrenal insufficiency

Adrenal insufficiency can be acute or chronic.

The acute form of adrenal insufficiency is manifested by the development of a serious condition - Addisonian crisis, which usually represents decompensation of the chronic form of the disease. The course of the chronic form of adrenal insufficiency can be compensated, subcompensated or decompensated.

According to the initial disruption of hormonal function, chronic adrenal insufficiency is divided into primary and central (secondary and tertiary).

Primary adrenal insufficiency (1-NN, primary hypocorticism, Addison's or bronze disease) develops as a result of bilateral damage to the adrenal glands themselves, occurs in more than 90% of cases, regardless of gender, more often in adulthood and old age.

Secondary and tertiary adrenal insufficiency are much less common and occur due to lack of secretion of ACTH by the pituitary gland or corticoliberin by the hypothalamus, leading to atrophy of the adrenal cortex.

Causes of adrenal insufficiency

Primary adrenal insufficiency develops when 85-90% of the adrenal tissue is affected.

In 98% of cases, the cause of primary hypocortisolism is idiopathic (autoimmune) atrophy of the adrenal cortex. At the same time, for unknown reasons, autoimmune antibodies to the enzyme 21-hydroxylase are formed in the body, destroying healthy tissues and cells of the adrenal glands. Also, 60% of patients with the primary idiopathic form of adrenal insufficiency have autoimmune lesions of other organs, more often autoimmune thyroiditis. Tuberculosis of the adrenal glands occurs in 1-2% of patients and in most cases is combined with pulmonary tuberculosis.

A rare genetic disease, adrenoleukodystrophy, causes primary adrenal insufficiency in 1-2% of cases. As a result of a genetic defect on the X chromosome, there is a lack of an enzyme that breaks down fatty acids. The predominant accumulation of fatty acids in the tissues of the nervous system and adrenal cortex causes their degenerative changes.

It is extremely rare that coagulopathies, tumor metastases to the adrenal glands (usually from the lung or breast), bilateral adrenal infarction, HIV-associated infections, and bilateral removal of the adrenal gland lead to the development of primary adrenal insufficiency.

Severe suppurative diseases, syphilis, fungal infections and amyloidosis of the adrenal glands, malignant tumors, heart defects, the use of certain medications (anticoagulants, steroidogenesis blockers, ketoconazole, cloditan, spironolactone, barbiturates), etc. predispose to the development of atrophy of the adrenal cortex.

Secondary adrenal insufficiency is caused by destructive or tumor processes in the hypothalamic-pituitary region, leading to disruption of corticotropic function, resulting in:

tumors of the hypothalamus and pituitary gland: craniopharyngiomas, adenomas, etc.;
vascular diseases: hemorrhages in the hypothalamus or pituitary gland, carotid artery aneurysm;
granulomatous processes in the hypothalamus or pituitary gland: syphilis, sarcoidosis, granulomatous or autoimmune hypophysitis;
destructive and traumatic interventions: radiation therapy of the hypothalamus and pituitary gland, surgery, long-term treatment with glucocorticoids, etc.

Primary hypocortisolism is accompanied by a decrease in the secretion of adrenal hormones (cortisol and aldoatherone), which leads to metabolic disorders and the balance of water and salts in the body. With aldosterone deficiency, progressive dehydration develops due to loss of sodium and potassium retention (hyperkalemia) in the body. Fluid and electrolyte disorders cause disturbances in the digestive and cardiovascular systems.

A decrease in cortisol levels reduces glycogen synthesis, leading to the development of hypoglycemia. In conditions of cortisol deficiency, the pituitary gland begins to increase the production of ACTH and melanocyte-stimulating hormone, which causes increased pigmentation of the skin and mucous membranes. Various physiological stresses (injuries, infections, decompensation of concomitant diseases) cause the progression of primary adrenal insufficiency.

Secondary hypocortisolism is characterized only by a deficiency of cortisol (as a result of ACTH deficiency) and persistence of aldosterone production. Therefore, secondary adrenal insufficiency, compared to primary, is relatively easy.

Symptoms of adrenal insufficiency

The leading criterion for primary chronic adrenal insufficiency is hyperpigmentation of the skin and mucous membranes, the intensity of which depends on the duration and severity of hypocortisolism. Initially, exposed areas of the body exposed to solar radiation acquire a darker color - the skin of the face, neck, hands, as well as areas that normally have darker pigmentation - nipple areolas, external genitalia, scrotum, perineum, axillary areas. A characteristic sign is hyperpigmentation of the palmar folds, noticeable against the background of lighter skin, darkening of areas of the skin that are in greater contact with clothing. Skin color varies from light tan, bronze, smoky, dirty skin to diffuse dark. Pigmentation of the mucous membranes (inner surface of the cheeks, tongue, palate, gums, vagina, rectum) is bluish-black in color.

Less common is adrenal insufficiency with mild hyperpigmentation - “white Addisonism.” Often, against the background of areas of hyperpigmentation, patients are found to have non-pigmented light spots - vitiligo, ranging in size from small to large, irregularly shaped, standing out on darker skin. Vitiligo occurs exclusively in autoimmune primary chronic hypocortisolism.

In patients with chronic adrenal insufficiency, body weight decreases from moderate weight loss (3-5 kg) to significant malnutrition (15-25 kg). Asthenia, irritability, depression, weakness, lethargy, up to loss of ability to work, and decreased libido are noted. Orthostatic (with a sharp change in body position) arterial hypotension and fainting caused by psychological shocks and stress are observed. If the patient has a history of hypertension before developing adrenal insufficiency, blood pressure may be within normal limits. Digestive disorders almost always develop - nausea, loss of appetite, vomiting, epigastric pain, loose stools or constipation, anorexia.

At the biochemical level, there is a disturbance in protein (decreased protein synthesis), carbohydrate (decrease in fasting glucose levels and a flat sugar curve after a glucose load), water-salt (hyponatremia, hyperkalemia) metabolism. Patients have a pronounced addiction to eating salty foods, even consuming pure salt, associated with an increasing loss of sodium salts.

Secondary adrenal insufficiency occurs without hyperpigmentation and symptoms of aldosterone deficiency (arterial hypotension, salt cravings, dyspepsia). It is characterized by nonspecific symptoms: symptoms of general weakness and attacks of hypoglycemia that develop several hours after eating.

Complications of adrenal insufficiency

The most dangerous complication of chronic hypocortisolism if not treated or treated incorrectly is an adrenal (Addisonian) crisis - a sharp decompensation of chronic adrenal insufficiency with the development of a coma. Addisonian crisis is characterized by severe weakness (up to a state of prostration), a drop in blood pressure (up to collapse and loss of consciousness), uncontrollable vomiting and loose stools with a rapid increase in dehydration, the smell of acetone from the breath, clonic convulsions, heart failure, even greater pigmentation of the skin covers.

Acute adrenal insufficiency (Addisonian crisis), based on the prevalence of symptoms, can occur in three clinical forms:

cardiovascular, in which circulatory disorders dominate: pale skin, acrocyanosis, cold extremities, tachycardia, arterial hypotension, threadlike pulse, collapse, anuria;
gastrointestinal, reminiscent in symptoms of signs of food poisoning or a clinical picture of an acute abdomen. Spasmodic pain in the abdomen, nausea with uncontrollable vomiting, loose stools with blood, and flatulence occur.
neuropsychic, with a predominance of headache, meningeal symptoms, convulsions, focal symptoms, delirium, lethargy, stupor.

Addisonian crisis is difficult to relieve and can cause the death of the patient.

Diagnosis of adrenal insufficiency

Diagnosis of adrenal insufficiency begins with an assessment of the medical history, complaints, physical data, and clarification of the cause of hypocortisolism. An ultrasound scan of the adrenal glands is performed. Primary adrenal insufficiency of tuberculous origin is indicated by the presence of calcifications or foci of tuberculosis in the adrenal glands; with the autoimmune nature of hypocortisolism, autoantibodies to adrenal antigen 21-hydroxylase are present in the blood. Additionally, an MRI or CT scan of the adrenal glands may be required to identify the causes of primary adrenal insufficiency. In order to establish the causes of secondary insufficiency of the adrenal cortex, CT and MRI of the brain.

With primary and secondary adrenal insufficiency, there is a decrease in cortisol in the blood and a decrease in the daily excretion of free cortisol and 17-OX in the urine. Primary hypocortisolism is characterized by an increase in ACTH concentration, while secondary hypocortisolism is characterized by a decrease. If there is doubtful evidence for adrenal insufficiency, a stimulation test with ACTH is performed, determining the level of cortisol in the blood half an hour and an hour after the administration of adrenocorticotropic hormone. An increase in cortisol levels of less than 550 nmol/L (20 mcg/dL) indicates adrenal insufficiency.

To confirm secondary adrenal insufficiency, an insulin hypoglycemia test is used, which normally causes a significant release of ACTH and a subsequent increase in cortisol secretion. With primary adrenal insufficiency, hyponatremia, hyperkalemia, lymphocytosis, eosinophilia and leukopenia are determined in the blood.

Treatment of adrenal insufficiency

Modern endocrinology has effective methods for treating adrenal insufficiency. The choice of treatment method depends primarily on the cause of the disease and has two goals: eliminating the cause of adrenal insufficiency and replacing hormonal deficiency.

Eliminating the cause of adrenal insufficiency includes drug treatment of tuberculosis, fungal diseases, syphilis; antitumor radiation therapy to the hypothalamus and pituitary gland; surgical removal of tumors, aneurysms. However, in the presence of irreversible processes in the adrenal glands, hypocortisolism persists and requires lifelong replacement therapy with adrenal hormones.

Treatment of primary adrenal insufficiency is carried out with glucocorticoid and mineralocorticoid drugs. For mild manifestations of hypocortisolism, cortisone or hydrocortisone is prescribed; for more pronounced manifestations, a combination of prednisolone, cortisone acetate or hydrocortisone with mineralocorticoids (deoxycorticosterone trimethyl acetate, DOXA - deoxycorticosterone acetate) is prescribed. The effectiveness of therapy is assessed by blood pressure, gradual regression of hyperpigmentation, weight gain, improvement in well-being, disappearance of dyspepsia, anorexia, muscle weakness, etc.

Hormonal therapy in patients with secondary adrenal insufficiency is carried out only with glucocorticoids, since aldosterone secretion is preserved. Under various stress factors (injuries, operations, infections, etc.), the dose of corticosteroids is increased by 3-5 times; during pregnancy, a slight increase in the dose of hormones is possible only in the second trimester.

The prescription of anabolic steroids (nandrolone) for chronic adrenal insufficiency is indicated for both men and women in courses up to 3 times a year. Patients with hypocortisolism are recommended to follow a diet enriched with protein, carbohydrates, fats, sodium salts, vitamins B and C, but with a limitation of potassium salts. To relieve the phenomena of Addisonian crisis, the following is carried out:

rehydration therapy with isotonic NaCl solution in a volume of 1.5-2.5 liters per day in combination with 20% glucose solution;
intravenous replacement therapy with hydrocortisone or prednisolone with a gradual reduction in dose as the symptoms of acute adrenal insufficiency subside;
symptomatic treatment of diseases leading to decompensation of chronic adrenal insufficiency (usually antibacterial therapy for infections).

Forecast and prevention of adrenal insufficiency

In the case of timely administration of adequate hormone replacement therapy, the course of adrenal insufficiency is relatively favorable. The prognosis in patients with chronic hypocortisolism is largely determined by the prevention and treatment of adrenal crises. In case of infections, injuries, surgical operations, stress, or gastrointestinal disorders associated with the disease, an immediate increase in the dose of the prescribed hormone is necessary.

It is necessary to actively identify and register with an endocrinologist patients with adrenal insufficiency and people at risk (long-term users of corticosteroids for various chronic diseases).

What is possible and not possible during the Nativity Fast?

In 2018, the Nativity Fast will begin on November 28. During this period, Orthodox believers prepare to celebrate Christmas...
A powerful prayer from her husband's mistress

Starting a family is the dream of most women. They want to have a loving husband and a bunch of kids. But it's not always a relationship...
Prayer to prevent divorce from your husband Prayer to keep your husband before divorce

This article contains: the most powerful prayer for divorce - information taken from all corners of the world, the electronic network and...
Strong prayer against quarrels and insults with your husband or wife Prayer not to divorce your wife

Information site about icons, prayers, Orthodox traditions. Prayer for scandals and quarrels in the family, with husband, with children...
Herring under a fur coat - a classic recipe

What would New Year be without champagne, tangerines, Olivier, aspic and everyone’s favorite “Herring under a fur coat”. With the last one...
How to make oatmeal cookies from oatmeal at home

Let's prepare the necessary ingredients for the cookies. The first thing to do is put the water to boil. We need...

2024-01-29 02:58:13

The financial director has it in his genes that the chief accountant must report to him. The difference between a financial director and a chief accountant.

Is it possible to register an employee for the position of financial director - chief accountant? The chief accountant claims...
2024-01-29 02:58:13

Development of enterprise budgets using the example of Uyut LLC Drawing up an annual budget for an enterprise

The head of a small business can easily manage the budget independently. CHECKED! If you manage...

2024-01-29 02:58:13

Place of a business plan in the life cycle

The creation of new projects involves a preliminary economic justification for their feasibility, subsequent...
2024-01-29 02:58:13

Development of a risk management program at the enterprise Risk report plan form

Reporting is generated by the RM, is agreed upon (approved) by the Risk Committee under the Management Board and transmitted to...

2024-01-28 03:22:01

Ecological tales about ladybugs

At the edge of a large, very large meadow, on a long emerald blade of grass lived a tiny Ladybug. God's little...
2024-01-27 04:33:53

Compatibility of Libra with other zodiac signs

Nowadays, it is quite common for people to turn to the stars. With the help of a horoscope a person can find out...

2024-01-27 04:33:53

Why do you dream of catching up with a man? Why do you dream of catching up with your loved one?

Business or friendly. If you were pursuing a stranger, it means your level of trust in the female sex...
2024-01-27 04:33:53

Dream Interpretation: Why do you dream about fish?

according to Freud's dream book If you dreamed about how you were fishing, it means that in real life you can hardly switch off...

2024-01-26 02:52:15
New Year's salad recipes (2016) Meat salad with prunes

The New Year's whirlwind will spin us around so quickly and rapidly that it's time to thoroughly think through the New Year's...
2024-01-26 02:52:15
Vinaigrette with homemade pickles

The article offers you some of the most delicious recipes for making vinaigrette. Vinaigrette is a delicious salad...
2024-01-26 02:52:15
Recipe: Cookies "Straws" - salted Recipes for salted straws for tea

July 4th, 2015 , 08:33 pm Lately, our Nastena has been completely giving up sweets (and thank God),...
2024-01-26 02:52:15
Soviet recipes for Negro kiss cake

Fragrant, very tasty chocolate cake, you can’t stop eating! The Negro’s Kiss cake is very easy to prepare,...
2024-01-25 01:29:08
Dream interpretation of a dead man being alive

Dream interpretation is an ancient art that allows you to at least assess the psychological status...
2024-01-25 01:29:08
Why accidentally break a mirror at home?

As soon as the first mirrors were born, people immediately endowed them with all sorts of mystical...
2024-01-31 04:57:39
What is possible and not possible during the Nativity Fast?

In 2018, the Nativity Fast will begin on November 28. During this period, Orthodox believers prepare to meet...

2024-01-31 04:57:39

A powerful prayer from her husband's mistress

Starting a family is the dream of most women. They want to have a loving husband and a bunch of kids. But it's not always...
2024-01-31 04:57:39

Prayer to prevent divorce from your husband Prayer to keep your husband before divorce

This article contains: the most powerful prayer for divorce - information taken from all over the world, electronic...

Symptoms of cardiovascular disease

Causes of chronic manifestations of the disease

Symptoms of hypocortisolism

Acute failure and its causes

Acute symptoms

Symptoms of cardiovascular disease

Gastrointestinal form of manifestations

Neuropsychic form of disorder

Carrying out diagnostic activities

Treatment of the disease

Treatment of chronic failure

Prevention

Diet

Prognosis of the course of the disease

Classification

Causes and mechanism of development of adrenal insufficiency

Symptoms of adrenal insufficiency

Diagnosis of adrenal hypofunction

General information

Classification of adrenal insufficiency

Causes of adrenal insufficiency

Symptoms of adrenal insufficiency

Complications of adrenal insufficiency

Diagnosis of adrenal insufficiency

Treatment of adrenal insufficiency

Forecast and prevention of adrenal insufficiency

Random articles

Advertising

Low hemoglobin

ALT and AST

Lymphocytes

Leukocytes

New

Popular