HORMONAL DISEASES
Hormones play a large and important role in everyone's daily health and well-being. Disease, certain stages of life and different health conditions can affect your body's ability to make or use the hormones you need. You will find more information here about specific diseases and conditions that affect hormones and health, and learn about the available treatment options.
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ADRENAL INSUFFICIENCY
The adrenal glands, located on top of the kidneys, make hormones that are essential for body functions. The outer layer (cortex) of the adrenal glands makes three types of steroid hormones. In adrenal insufficiency (AI), the cortex does not make enough steroid hormones.
There are two kinds of Adrenal Insufficiency:
- Primary Adrenal Insufficiency, also called Addison’s disease. In this rare condition, the adrenal glands do not work properly and cannot make enough cortisol (a “stress” hormone). Usually, production of aldosterone and androgens (the other hormones made by the adrenal glands) is also low.
- Secondary Adrenal Insufficiency. This far more common type of AI results when the pituitary gland, a small gland near the brain, does not signal the adrenal glands to make cortisol.
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The adrenal glands do not get “adrenal fatigue” or lose function because of mental or physical stress. True AI is a rare health problem. Only an endocrinologist, an expert in hormones, should diagnose it using standard tests.
HARM OF ADRENAL INSUFFICIENCY
Problems can occur in people with adrenal insufficiency who are undergoing surgery, suffer a severe injury, have an illness, or are pregnant. These conditions place additional stress on the body, and people with adrenal insufficiency may need additional treatment to respond and recover.
Surgery
People with adrenal insufficiency who need any type of surgery requiring general anesthesia must be treated with IV corticosteroids and saline. IV treatment begins before surgery and continues until the patient is fully awake after surgery and is able to take medication by mouth. The “stress” dosage is adjusted as the patient recovers until the regular, presurgery dose is reached.
In addition, people who are not currently taking corticosteroids, yet have taken long-term corticosteroids in the past year, should tell their health care provider before surgery. These people may have sufficient ACTH for normal events; however, they may need IV treatment for the stress of surgery.
Severe Injury
Patients who suffer severe injury may need a higher, “stress” dosage of corticosteroids immediately following the injury and during recovery. Often, these stress doses must be given intravenously. Once the patient recovers from the injury, dosing is returned to regular, pre-injury levels.
Illness
During an illness, a person taking corticosteroids orally may take an adjusted dose to mimic the normal response of the adrenal glands to this stress on the body. Significant fever or injury may require a triple dose. Once the person recovers from the illness, dosing is then returned to regular, pre-illness levels. People with adrenal insufficiency should know how to increase medication during such periods of stress, as advised by their health care provider. Immediate medical attention is needed if severe infections, vomiting, or diarrhea occur. These conditions can lead to an adrenal crisis.
Pregnancy
Women with adrenal insufficiency who become pregnant are treated with the same hormone therapy taken prior to pregnancy. However, if nausea and vomiting in early pregnancy interfere with taking medication orally, injections of corticosteroids may be necessary. During delivery, treatment is similar to that of people needing surgery. Following delivery, the dose is gradually lessened, and the regular dose is reached about 10 days after childbirth.
Surgery
People with adrenal insufficiency who need any type of surgery requiring general anesthesia must be treated with IV corticosteroids and saline. IV treatment begins before surgery and continues until the patient is fully awake after surgery and is able to take medication by mouth. The “stress” dosage is adjusted as the patient recovers until the regular, presurgery dose is reached.
In addition, people who are not currently taking corticosteroids, yet have taken long-term corticosteroids in the past year, should tell their health care provider before surgery. These people may have sufficient ACTH for normal events; however, they may need IV treatment for the stress of surgery.
Severe Injury
Patients who suffer severe injury may need a higher, “stress” dosage of corticosteroids immediately following the injury and during recovery. Often, these stress doses must be given intravenously. Once the patient recovers from the injury, dosing is returned to regular, pre-injury levels.
Illness
During an illness, a person taking corticosteroids orally may take an adjusted dose to mimic the normal response of the adrenal glands to this stress on the body. Significant fever or injury may require a triple dose. Once the person recovers from the illness, dosing is then returned to regular, pre-illness levels. People with adrenal insufficiency should know how to increase medication during such periods of stress, as advised by their health care provider. Immediate medical attention is needed if severe infections, vomiting, or diarrhea occur. These conditions can lead to an adrenal crisis.
Pregnancy
Women with adrenal insufficiency who become pregnant are treated with the same hormone therapy taken prior to pregnancy. However, if nausea and vomiting in early pregnancy interfere with taking medication orally, injections of corticosteroids may be necessary. During delivery, treatment is similar to that of people needing surgery. Following delivery, the dose is gradually lessened, and the regular dose is reached about 10 days after childbirth.
ADRENAL INSUFFICIENCY SYMPTOMS
The symptoms of adrenal insufficiency usually begin gradually. Early symptoms may include:
- Unusual fatigue and muscle weakness
- Dizziness when standing
- Nausea, vomiting and/or diarrhea
- Loss of appetite
- Stomachache
Symptoms that may occur in the later stages of the disease include:
- Weight loss
- Dark tanning of the skin
- Craving for salt
Differentiating clinical or general laboratory features include the absence of hyperpigmentation and relatively normal electrolyte and BUN levels; hyponatremia, if it occurs, is usually dilutional.
Patients with panhypopituitarism have depressed thyroid and gonadal function and hypoglycemia. Coma may supervene when symptomatic secondary adrenal insufficiency occurs. Adrenal crisis is especially likely if a patient is treated for a single endocrine gland problem, particularly with thyroxine, without hydrocortisone replacement.
Link: http://tinyurl.com/lqk7qaw
The symptoms of adrenal insufficiency usually begin gradually. Early symptoms may include:
- Unusual fatigue and muscle weakness
- Dizziness when standing
- Nausea, vomiting and/or diarrhea
- Loss of appetite
- Stomachache
Symptoms that may occur in the later stages of the disease include:
- Weight loss
- Dark tanning of the skin
- Craving for salt
Differentiating clinical or general laboratory features include the absence of hyperpigmentation and relatively normal electrolyte and BUN levels; hyponatremia, if it occurs, is usually dilutional.
Patients with panhypopituitarism have depressed thyroid and gonadal function and hypoglycemia. Coma may supervene when symptomatic secondary adrenal insufficiency occurs. Adrenal crisis is especially likely if a patient is treated for a single endocrine gland problem, particularly with thyroxine, without hydrocortisone replacement.
PROGNOSIS OF ADRENAL INSUFFICIENCY
Untreated, adrenal insufficiency is fatal, and indeed this was invariably the case until the advent of synthetic cortisone in 1949. Treatment of Addison's disease is lifelong. The prognosis for any patient with adrenal insufficiency will depend on the underlying cause. In those patients in whom the prognosis is not affected by the underlying pathology, replacement therapy should result in a return to health. However, a Norwegian study found an excess of mortality in patients diagnosed with Addison's disease at a young age, associated with acute adrenal failure, infection and sudden death
Link: http://www.patient.co.uk/doctor/adrenal-insufficiency-and-addisons-disease
EFFECT OF ADRENAL INSUFFICIENCY ON HOMEOSTASIS
- Brain fog, cloudy-headedness and mild depression
- Low thyroid function
- Blood sugar imbalances, such as hypoglycemia
- Fatigue – especially morning and mid-afternoon fatigue
- Sleep disruption
- Low blood pressure
- Lowered immune function
- Inflammation
TREATMENT OF ADRENAL INSUFFICIENCY
Adrenal insufficiency results in a lack of essential hormones, and therefore treatment focuses on replacing or substituting those hormones. Cortisol is replaced orally with tablets taken once or twice a day. Aldosterone is replaced with oral doses of a mineralocorticoid, called fludrocortisone acetate, that are taken once a day. Fludrocortisone helps to maintain the right levels of salt and fluids in the body.
HOW HAS SCIENCE CONTRIBUTED TO OUR UNDERSTANDING OF ADRENAL SUFFICIENCY
Understanding the hormonal and endocrine system:
Endocrine glands make chemicals called hormones and pass them straight into the bloodstream. Hormones can be thought of as chemical messages.
From the blood stream, the hormones communicate with the body by heading towards their target cell to bring about a particular change or effect to that cell. The hormone can also create changes in the cells of surrounding tissues (paracrine effect). The endocrine system works with the nervous system and the immune system to help the body cope with different events and stresses.
This branch of medicine – relating to the study of the endocrine system – is called endocrinology and is practiced by endocrinologists. The field is rapidly expanding due to understanding of the cellular pathways that hormones stimulate and the discovery of new hormones and their actions.
Location of the Adrenal Glands
There are two adrenal glands which sit on top of each kidney. They make a number of different hormones. The outside part of the gland (adrenal cortex) makes cortisol, aldosterone and sex hormones. The centre of the adrenal gland (adrenal medulla) makes adrenaline. Adrenaline is an example of a hormone that is under the control of the nervous system.Without our understanding of the importance of hormones, we would not be capable of identifying adrenal disease and it's impact
Link: http://tinyurl.com/mmmt4qh
Diagnosis of adrenal insufficiency
ACTH Stimulation Test: This is the most specific test for diagnosing adrenal insufficiency. Blood cortisol levels are measured before and after a synthetic form of adrenocorticotrophic hormone (ACTH), a hormone secreted from the anterior pituitary, is given by injection.
Insulin-Induced Hypoglycemia Test: The insulin-induced hypoglycemia test is used to determine how the hypothalamus, pituitary and adrenal glands respond to stress. During this test, blood is drawn to measure the blood glucose and cortisol levels, followed by an injection of fast-acting insulin. Blood glucose and cortisol levels are measured again 30, 45 and 90 minutes after the insulin injection. The normal response is for blood glucose levels to fall (this represents the stress) and cortisol levels to rise.
Both methods use technology and biological knowledge that allow us to identify the symptoms of adrenal insufficiency in our body and thus allows the doctors to diagnose us appropriately.
Link: http://tinyurl.com/m9wzd3d
Endocrine glands make chemicals called hormones and pass them straight into the bloodstream. Hormones can be thought of as chemical messages.
From the blood stream, the hormones communicate with the body by heading towards their target cell to bring about a particular change or effect to that cell. The hormone can also create changes in the cells of surrounding tissues (paracrine effect). The endocrine system works with the nervous system and the immune system to help the body cope with different events and stresses.This branch of medicine – relating to the study of the endocrine system – is called endocrinology and is practiced by endocrinologists. The field is rapidly expanding due to understanding of the cellular pathways that hormones stimulate and the discovery of new hormones and their actions.
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| Location of the Adrenal Glands |
Diagnosis of adrenal insufficiency
ACTH Stimulation Test: This is the most specific test for diagnosing adrenal insufficiency. Blood cortisol levels are measured before and after a synthetic form of adrenocorticotrophic hormone (ACTH), a hormone secreted from the anterior pituitary, is given by injection.
Insulin-Induced Hypoglycemia Test: The insulin-induced hypoglycemia test is used to determine how the hypothalamus, pituitary and adrenal glands respond to stress. During this test, blood is drawn to measure the blood glucose and cortisol levels, followed by an injection of fast-acting insulin. Blood glucose and cortisol levels are measured again 30, 45 and 90 minutes after the insulin injection. The normal response is for blood glucose levels to fall (this represents the stress) and cortisol levels to rise.
