Adrenal insufficiency is a condition in which the adrenal glands do not produce enough hormones, including cortisol, a stress hormone vital for many bodily functions. The adrenal glands are small glands located just above the kidneys. They work with the pituitary glands in the brain and hypothalamus. Cortisol helps break down carbohydrates, fats, and proteins. It also controls blood pressure and affects the immune system.
There are three types of Adrenal Insufficiency:
- Primary Adrenal Insufficiency: Also known as Addison’s disease, it occurs when the adrenal glands are damaged and affect the production of hormones, including cortisol and aldosterone. This is a rare condition and may occur at any age.
- Secondary Adrenal Insufficiency: This occurs when the brain’s pituitary gland does not make enough ACTH (adrenocorticotropic), a hormone that influences cortisol production in the adrenal glands. As a result, leads to low hormone levels.
- Tertiary Adrenal Insufficiency: The hypothalamus in the brain, a region that influences hormone production in the adrenal glands, does not produce enough corticotropin-releasing hormone (CRH), leading to low hormone levels.
How do Surgeons Diagnose Adrenal Insufficiency?
Your adrenal specialist will assess the symptoms and may recommend some tests, which usually involve blood and urine tests. These can check the mineral levels and hormones in the blood for signs of the condition.
A doctor may also recommend imaging tests, including X-rays, ultrasound, and MRI scans, to assess the health of the adrenal or pituitary glands.
How do Surgeons Treat Adrenal Insufficiency?
There is no cure for adrenal insufficiency, but some treatment options can help people manage the symptoms. These options depend on the symptoms and severity of the disorder. The doctor will determine the best treatment based on age, overall health, past health, how sick you are, how well you can handle certain medicines, procedures, or therapies, how long the condition is expected to last, your opinion or preference, etc.Hormone Replacement
Hormone replacement therapy is a common type of treatment for adrenal insufficiency, which involves replacing the hormones that the adrenal glands no longer produce, including cortisol. To replace cortisol, the doctor will prescribe medications higher doses per day.
Corticosteroids, such as hydrocortisone, are used instead of cortisol. This medication is taken orally two to three times daily. In some cases, doctors may prescribe prednisone or dexamethasone.
If your adrenal glands fail to produce aldosterone, you’ll require fludrocortisone to regulate sodium and fluid levels in your body. However, people with secondary adrenal insufficiency generally produce sufficient aldosterone and may not need this medication.
Your doctor will suggest the dosage of each medication to suit your body’s requirements.
Treatment for adrenal crisis involves intravenous corticosteroid injections and large doses of saline solution infused with dextrose, a type of sugar, to stabilize your condition.
Treatment in Special Conditions
1. Pregnancy
During pregnancy, people with adrenal insufficiency can continue taking the same dosage of medication as before pregnancy. However, if experiencing nausea and vomiting in early pregnancy makes oral medication challenging, corticosteroid shots may be prescribed by your doctor.
The treatment during delivery is the same as that of people requiring surgery. After delivery, your doctor will slowly reduce your medication dosage. You can expect to return to your regular dosage approximately ten days after giving birth.
2. Illness
During illness, it’s important to discuss with your doctor how to manage your corticosteroid dosage. If you have a high fever, you need to increase your dosage. Once you recover, your doctor will adjust your dosage back to its regular level. However, if you face severe infection, diarrhea, or nausea preventing you from keeping down your corticosteroid pills, seek immediate medical attention. Without prompt treatment in an emergency room, if necessary, these conditions can lead to an adrenal crisis.3. Surgery
If you are having any surgery that includes general anesthesia, it’s common to receive corticosteroids and saline as part of your treatment regimen. This IV treatment begins before the surgery and persists until you are fully conscious and can resume oral medication intake. As you get better, your doctor will change the high dose of medicine you’re taking to help with stress. They’ll adjust it until it’s the same as what you were taking before your surgery.4. Injury or Other Severe Condition
In cases of severe injury or serious health conditions such as sudden loss of consciousness or coma, a higher dosage of corticosteroids, often termed as “stress” doses, may be necessary right after the injury and during the recovery period. These stress doses help to support the body’s response to stress and aid in the healing process.
Once the patient begins to recover, the doctor will gradually adjust the corticosteroid dosage back to the regular, pre-injury level. This ensures that the body receives the appropriate amount of medication according to its needs as recovery progresses. Additionally, close monitoring by an adrenal specialist is essential to ensure the prompt management of corticosteroid therapy during the recovery phase.
Conclusion
Adrenal insufficiency occurs when your adrenal glands can’t make enough hormones for your body. These glands mainly produce cortisol, and when there’s not enough, it can lead to many different symptoms, including chronic fatigue or extreme tiredness, muscle weakness, decreased appetite, weight loss, abdominal pains, joint pain, low blood pressure, dizziness, nausea, vomiting, irritability, depression, low blood sugar, irregular menstruation, loss of sex drive, darkening of the skin, such as the elbows and knees.
Fortunately, adrenal insufficiency can be treated with hormone replacement therapy. But sometimes, there can be a sudden crisis called adrenal shock. This is very serious and needs urgent medical attention.
