What is Adrenal Insufficiency

8/14/2019 What is Adrenal Insufficiency

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What is adrenal insufficiency?

Adrenal insufficiency means that there are not enough adrenal hormones.Without the right levels of these hormones, your body cannot maintainessential life functions.Adrenal insufficiency may be permanent or temporary. When AI ispermanent, medication must be taken daily for the rest of the patient's life.

Causes of permanent AI include the following: Addison Disease Congenital adrenal hyperplasia

(CAH) discovered in childhood complete surgical removal of the

pituitary gland

surgical removal of the adrenals.

Temporary adrenal insufficiency is brought on by physical stress, infection,surgery, or when the proper medication is not taken.

Causes of temporary AI include the following: transsphenoidal surgery for Cushing

disease that removes a tumor fromthe pituitary gland

removal of a tumor that has beencausing the adrenal glands to maketoo much cortisol

medical treatment for CushingSyndrome with drugs that lowercortisol levels.

medical treatment with steroids forprolonged periods of time

Signs and Symptoms

unusual tiredness and weakness dizziness when standing up nausea, vomiting, diarrhea loss of appetite stomach ache. weight loss


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darkened skin craving for salt

Cushing's Syndrome

Cushings disease is a condition in which the pituitary gland releases toomuch adrenocorticotropic hormone (ATCH). The pituitary gland is an organof the endocrine system.

Cushing's disease is a form ofCushing syndrome.

Causes

Cushing's disease is caused by a tumoror excess growth (hyperplasia) ofthe pituitary gland. This gland is located at the base of the brain.

People with Cushing's disease have too much ACTH. ACTH stimulates theproduction and release of cortisol, a stress hormone. Too much ACTH

means too much cortisol.

Cortisol is normally released during stressful situations. It controls thebody's use ofcarbohydrates, fats, and proteins and also helps reduce theimmune system's response to swelling (inflammation).

Symptoms

Symptoms usually include:

Upper body obesity (above the waist) and thin arms and legs

Round, red, full face (moon face)

Slow growth rate in children

Skin changes that are often seen:

Acne or skin infections

Purple marks (1/2 inch or more wide) called striae on the skin of theabdomen, thighs, and breasts

Thin skin with easy bruising

Muscle and bone changes include:

Backache, which occurs with routine activities

Bone pain or tenderness

Collection of fat between the shoulders (buffalo hump)

Thinning of the bones, which leads to rib and spine fractures

Weak muscles

Women often have:
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Excess hair growth on the face, neck, chest, abdomen, and thighs

Menstrual cycle becomes irregular or stops

Men may have:

Decreased fertility

Decreased or no desire for sex

Impotence

Other symptoms that may occur include:

Mental changes, such as depression, anxiety, or changes in behavior

Fatigue

Headache

High blood pressure

Increased thirst and urination

Exams and Tests:

Blood ACTH level

Brain MRI

Corticotropin-releasing hormone test, which acts on the pituitarygland to cause the release of ACTH

Dexamethasone suppression test (high dose)

Petrosal sinus sampling - measures ACTH levels in the veins that

drain the pituitary gland

Treatment:

Treatment involves surgery to remove the pituitary tumor, if possible. Aftersurgery, the pituitary may slowly start to work again and return to normal.

During the recovery process, you may need cortisol replacementtreatments. Radiation treatment of the pituitary gland may also be used.

If the tumor does not respond to surgery or radiation, you may getmedications to stop your body from making cortisol.

If these treatments are not successful, the adrenal glands may need to beremoved to stop the high levels of cortisol from being produced.

Outlook (Prognosis)
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Untreated, Cushing's disease can cause severe illness, even death.Removal of the tumor may lead to full recovery, but the tumor can growback.

Possible Complications:

Compression fractures Diabetes

High blood pressure

Infections

Kidney stones

Psychosis

ADRENAL INSUFFICIENCY

Addisons disease

is a disorder that occurs when the adrenal glands do not produce

enough of their hormones.

Causes:

The adrenal glands are small hormone-secreting organs located on top of

each kidney. They consist of the outer portion (called the cortex) and theinner portion (called the medulla).

The cortex produces 3 types of hormones:

The glucocorticoid hormones (such as cortisol) maintain sugar(glucose) control, decrease (suppress) immune response, and helpthe body respond to stress.
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The mineralocorticoid hormones (such as aldosterone) regulatesodium and potassium balance.

The sex hormones, androgens (male) and estrogens (female), affectsexual development and sex drive.

Addison's disease results from damage to the adrenal cortex. The damagecauses the cortex to produce less of its hormones.

This damage may be caused by the following:

The immune system mistakenly attacking the gland (autoimmunedisease)

Infections such as tuberculosis, HIV, or fungal infections

Hemorrhage, blood loss

Tumors

Use of blood-thinning drugs (anticoagulants)

Symptoms:

Changes in blood pressure or heart rate

Chronic diarrhea

Darkening of the skin - patchy skin color Unnaturally dark color in some places

Paleness

Extreme weakness

Fatigue

Loss of appetite

Mouth lesions on the inside of a cheek (buccal mucosa)

Nausea and vomiting

Salt craving

Slow, sluggish movement

Unintentional weight loss

Exams and Tests:

Increased potassium
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Low blood pressure

Low cortisol level

Low serum sodium

Normal sex hormone levels

Other tests may include:

Abdominal x-ray

Abdominal CT scan

Treatment:

Treatment with replacement corticosteroids will control the symptoms ofthis disease. However, you will usually need to take these drugs for life.People often receive a combination of glucocorticoids (cortisone orhydrocortisone) and mineralocorticoids (fludrocortisone).

Possible Complications:

Complications also may result from the following related illnesses:

Diabetes

Hashimoto's thyroiditis (chronic thyroiditis)

Hypoparathyroidism Ovarian hypofunction ortesticular failure

Pernicious anemia

Thyrotoxicosis
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Coffee and tea

banana

vanilla

chocolates

Management:

surgery

Nursing Care:

monitor BPin supine and standing

monitor for glucose and acetone

Primary aldosteronism

A condition which the bodys adrenal glands produce too much

aldosterone, causing loss potassium and sodium retention. The excess

sodium in turn holds onto water, increasing blood volume and blood

pressure.

Signs and Symptoms:

hypokalemia

increases neuromuscular

irritability and produces muscle weakness

fatigue

Headaches

Paresthesia

flaccid paralysis

elevated BP

Causes:


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Common conditions causing the overproduction of aldosterone include:

A benign growth (aldosteronoma) in an adrenal gland a conditionalso known as Conn's syndrome

Overactivity of both adrenal glands (bilateral adrenal hyperplasia)

In rare cases, primary aldosteronism may be caused by:

Cancerous (malignant) growths in the outer layer (cortex) of theadrenal gland

Genetic mutations

A rare type of primary aldosteronism called glucocorticoid-remediablealdosteronism (GRA) that runs in families and causes high bloodpressure in children and young adults

Complications:

The most serious complication of primary aldosteronism is high bloodpressure. Untreated high blood pressure can lead to:

Heart attack

Heart failure

Left ventricular hypertrophy enlargement of the muscle that makes

up the wall of the left ventricle, your heart's main pumping chamber

Stroke

Kidney disease or kidney failure

Premature death

Tests and Diagnosis:

Oral salt loading. You'll follow a high-sodium diet for three daysbefore your doctor measures aldosterone and sodium levels in yoururine.

Saline loading. Your aldosterone levels are tested after sodium mixedwith water (saline) is infused into your bloodstream for several hours.

Fludrocortisone suppression test (FST). After you've followed a high-sodium diet and taken fludrocortisone which mimics the action of


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aldosterone for three days, aldosterone levels in your blood aremeasured.

Abdominal computerized tomography (CT) scan. A CT scan can helpidentify a tumor on your adrenal gland or an enlargement that

suggests overactivity. Adrenal vein sampling. This is the most reliable test for determining

the cause of primary aldosteronismLifestyle and home remedies,

Management:

Follow a healthy diet. Limit the sodium in your diet by focusing onfresh foods and reduced-sodium products, avoiding condiments, andremoving salt from recipes. Diets that also emphasize a healthyvariety of foods including grains, fruits, vegetables and low-fatdairy products can promote weight loss and help to lower blood

pressure. Try the Dietary Approaches to Stop Hypertension (DASH)diet it has proven benefits for your heart.

Achieve a healthy weight. If your body mass index (BMI) is 25 ormore, losing as few as 10 pounds may reduce your blood pressure.

Exercise. Regular aerobic exercise seems to lower blood pressure insome people, even without weight loss. You don't have to hit the gym taking vigorous walks most days of the week can significantlyimprove your health. Try walking with a friend at lunch instead ofdining out.

Don't smoke. If you smoke, stop. Nicotine in tobacco makes yourheart work harder by temporarily constricting your blood vessels andincreasing your heart rate and blood pressure. Talk to your doctorabout medications that can help you stop smoking.

Limit alcohol and caffeine. Both substances can raise your bloodpressure, and alcohol can interfere with the effectiveness of someblood pressure medications. Ask your doctor whether moderatealcohol consumption is safe for you.


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Glossary Terms

abdomen:

Also referred to as the belly. It is the part of the body that contains all of the internal structuresbetween the chest and the pelvis.

adrenal:

Glands that reside above the kidneys composed of an inner medulla and an outer cortex.

adrenal cortex:

The outer layer of the adrenal gland.

adrenal gland:

One of a pair of small glands, each of which sits on top of one of the kidneys. These glandsproduce hormones that help control heart rate, blood pressure, the way the body uses food andother vital functions.

adrenal medulla:

Inner portion of the adrenal gland.

adrenaline:

Also known as epinephrine. Hormone secreted in the adrenal gland that raises blood pressure,produces a rapid heartbeat and acts a neurotransmitter when the body is subjected to stress ordanger.

aldosterone:

An adrenal hormone critical for salt (sodium) balance. Produced by the outer part of theadrenal cortex, its action causes a reabsorption of sodium and secretion of potassium and iscritical for the maintenance of blood pressure.

alpha-adrenergic blockers:


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Also known as alpha-blockers. Drugs used to treat high blood pressure and other conditionslike an enlarged prostate or stress urinary incontinence.

anesthesia:

Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often

used during surgery to put a person to sleep.

anxiety:

A feeling of apprehension, often characterized by feelings of stress.

benign:

Not malignant; not cancerous.

cancer:

An abnormal growth that can invade nearby structures and spread to other parts of the bodyand may be a threat to life.

catecholamine:

Type of organic compound.

cortex:

The outer layer of an organ.

cortisone:

A hormone secreted by the adrenal gland and used to treat rheumatoid arthritis and allergies.

CT scan:

Also known as computerized tomography, computerized axial tomography or CT scan. Adiagnostic imaging procedure that uses a combination of X-rays and computer technology toproduce cross-sectional images of the body. Shows detailed images of any part of the body,including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

degradation products:

Something made to decline to a lower condition, quality or level.

diagnosis:

The process by which a doctor determines what disease or condition a patient has by studyingthe patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets,urine tests, brain scans, etc.).

endocrine:

Relating to glands that secrete hormones internally directly into the lymph nodes orbloodstream.


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endocrine glands:

Any gland of the body that secretes hormones directly into the lymph nodes or bloodstream.

epinephrine:

Also known as adrenaline. Hormone secreted in the adrenal gland that raises blood pressure,

produces a rapid heartbeat and acts as a neurotransmitter when the body is subjected to stressor danger.

gland:

A mass of cells or an organ that removes substances from the bloodstream and excretes themor secretes them back into the blood with a specific physiological purpose.

glucagons:

A hormone responsible for helping maintain proper blood sugar levels.

high blood pressure:Medical term is hypertension.

histamine:

A hormone transmitter involved in local immune response regulating stomach acid productionand in allergic reactions.

hormone:

A natural chemical produced in one part of the body and released into the blood to trigger orregulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow downurine production.

hypertension:

High blood pressure, which can be caused either by too much fluid in the blood vessels or bythe narrowing of blood vessels.

hypertensive:

Having high blood pressure.

incision:

Surgical cut for entering the body to perform an operation.

invasive:

Having or showing a tendency to spread from the point of origin to adjacent tissue, as somecancers do. Involving cutting or puncturing the skin or inserting instruments into the body.

ions:

Electrically charged atoms.


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kidney:

One of two bean-shaped organs that filter wastes from the blood and discharge these wasteproducts in urine. The kidneys are located on either side at the level of the 12th ribs toward theback. The kidneys send urine to the bladder through tubes called ureters.

kidneys:One of two bean-shaped organs that filter wastes from the blood and discharge these wasteproducts in urine. The kidneys are located on either side at the level of the 12th ribs toward theback. The kidneys send urine to the bladder through tubes called ureters.

laparoscope:

An instrument in the shape of a tube that is inserted through the abdominal wall to give anexamining doctor a view of the internal organs.

laparotomy:

An operation in which the abdominal cavity is opened and inspected directly.

medulla:

The innermost area of an organ.

meta-iodobenzylguanidine:

A radioisotope.

metastatic:

Cancer that has metastasized, in other words, spread to other parts of the body.

MRI:Also referred to a magnetic resonance imaging. A diagnostic procedure that uses acombination of large magnets, radiofrequencies and a computer to produce detailed images oforgans and structures within the body.

pharmacologic:

Reaction to drugs.

pheochromocytoma:

A tumor of the adrenal gland, which is typically benign (non-cancerous).

renal:

Pertaining to the kidneys.

thyroid:

An endocrine gland located in the neck that secretes the hormones responsible for controllingmetabolism and growth.


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tumor:

An abnormal mass of tissue or growth of cells.

tyramine:

Normal substance in the body that helps support blood pressure.

urge:

Strong desire to urinate.

urine:

Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelledfrom the body through the urethra by the act of urinating (voiding). About 96 percent of whichis water and the rest waste products.

urologist:

A doctor who specializes in diseases of the male and female urinary systems and the malereproductive system.

Addison diseaseAn illness caused by the failure of theadrenal glands to secrete enough adrenalhormones.

Adrenal glandsTwo glands, each located above a kidney,

that secrete cortisol and otheressential hormones.

AldosteroneA hormone made by the adrenal glandsthat regulates salt, potassium, and waterin the body.

Congenital Adrenal Hyperplasia (CAH)A deficiency of adrenal hormones that ispresent from birth.

CortisolA hormone secreted by the adrenalglands that regulates carbohydrate andprotein metabolism.

Cushing diseaseA pituitary tumor that makes too muchACTH and causes Cushing syndrome


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Cushing syndromeAn illness caused when too much cortisolis made by the adrenal glands.

Glucocorticoid

A hormone that is produced by the adrenalcortex that is involved in carbohydrate,protein, and fat metabolism andhas anti-inflammatory properties

HydrocortisoneA form of cortisol. This is the drug usedto replace cortisol in the body.

Transsphenoidal surgeryHighly specialized neurosurgery in which

tumors are removed from the pituitarygland.

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What is Adrenal Insufficiency