Acute and chronic, primary and secondary adrenal insufficiency: symptoms, diagnosis, treatment

In medicine, adrenal insufficiency( hypokorticism) refers to all diseases caused by a decrease in the function of the adrenal glands. That is, when the body suffers from a shortage of a number of hormones. Hypocorticism is congenital and acquired, it can hide for years or declare itself a sharp attack. The main victims of endocrine pathology are adults over 30 years of age, while the disease does not depend on sex, race or social status.

Adrenal insufficiency

Adrenal insufficiency is a condition in which the adrenal glands, for whatever reason, can not perform their natural function.

That is, synthesize vitally important for human hormones:

  • mineralocorticoids( deoxycorticosterone, aldosterone, corticosterone);
  • glucocorticoids( cortisol and cortisone);
  • epinephrine with norepinephrine( hormones "rage" and "stress");
  • a small amount of sex hormones.

The same control the adrenal glands with the help of their "personal" hormones - ACTH and corticoliberin, respectively. If there is a failure in any part of the pyramid "hypothalamus → hypophysis → adrenal glands," this causes a problem in the activity of the lower organs.

Diagnosis and situations where the amount of hormones is enough, but the receptors in the body do not react to them: either lose sensitivity, or are blocked by other substances. This phenomenon is also referred to as hypocorticism.
On adrenal insufficiency video:

Classification of

Functional adrenal disorder can occur for a variety of reasons, from innocent infection to severe trauma or multiple endocrine disorders. Therefore, the classification of adrenal insufficiency syndrome is complex, for several reasons.

Primary insufficiency( the most "popular" species, 90% of all cases of hypocorticism) is called the primary form of the disease, depending on where the primary disease is localized. In this case, the adrenal glands are affected.

  • Secondary failure. The reason is a malfunction in the pituitary gland.
  • Tertiary insufficiency. First, the hypothalamus hits, the pituitary does not receive signals in time, and the adrenal gland function suffers.
  • Sometimes the same classification includes iatrogenic( drug) insufficiency. It develops on the background of hormone therapy - as a withdrawal syndrome after a sharp cessation of treatment. This form is very rare, 4-11 cases per 100 thousand people, and occurs mainly in women older than 30 years.

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    In accordance with the nature of the syndrome, there are 2 types: acute and chronic forms.

    Chronic adrenal hypofunction( in another way - Addison's disease) can last for years and only after severe stress( illness, trauma, nervous strain, tragedy in the family, etc.).Under stress, the body requires cortisol to make up for energy reserves, adjust the glucose flow, coordinate the work of the brain and the cardiovascular system. And if cortisol is not enough, the ailment can seriously deteriorate or go into the acute phase.

    Reasons for

    Adrenal glands, like other endocrine organs, have excellent compensatory capabilities. If a problem arises, they begin to work in a strengthened mode, at any cost to provide the body with the necessary "portion" of hormones.

    To develop primary failure, damage should touch 85-90% of the cortex of these paired organs.

    This happens when:

    • autoimmune disorders, when the adrenal cells attack their own antibodies( this is the main cause of the pathology);
    • congenital hypofunction of organs in toddlers( hypoplasia of the adrenal cortex, etc.);
    • tuberculosis( predominantly in adults);
    • cancers and metastases;
    • complications after surgery;
    • long admission of potent drugs;
    • of tissue death of organs with HIV infection, etc.
    Causes of primary adrenal insufficiency


    Causes of secondary and tertiary hypocorticism:
    • infectious pathologies of endocrine organs( complications after illness);
    • hemorrhage due to injury;
    • tumors;
    • congenital hypophyseal hypothyroidism and hypothalamus;
    • autoimmune attacks on the pituitary gland.

    Acute adrenal insufficiency most often provokes thrombosis, malignant tumors, tuberculosis, severe infections( herpes, toxoplasmosis, diphtheria), drug withdrawal syndrome. In children under 3 years of age, an ordinary cold or stress can provide an endocrine crisis.

    Signs and Symptoms of

    Symptoms of chronic hypokorticism may not appear for several years. Exception - only congenital forms, with their external signs of adrenal inaccessibility in children are noticeable in the first months of life. If the disease is caused by autoimmune factors, it often manifests itself only after 6-7 years.

    The pathology appears gradually, the first signs are nonspecific: weakness, severe weight loss, low blood pressure, nausea and vomiting.

    The hypofunction of the adrenal glands is clearly indicated by the following symptoms:

    1. Strong pigmentation of the skin and mucous membranes.

    This is a sign of primary hypokorticism. Dark( up to the dark brown shade) visible areas of the skin, not covered by clothing, mucous, as well as areas of the body that are initially darker than others: the crotch, nipples, scrotum. If the disease has autoimmune causes, white spots appear on the body - vitiligo( depigmentation).

    The main symptoms of chronic adrenal insufficiency

    1. Behavior disorders.

    The person becomes apathetic, constantly nervous, easily annoyed. Often develop depressive disorders.

    1. Digestive problems.

    Nausea, vomiting, decreased appetite( sometimes reaching anorexia) - clear signals of adrenal patients. The patient complains of incomprehensible, "wandering" pain in the abdomen, constant vomiting. Constipation and diarrhea can alternate.

    1. Other signs.

    With a deficiency of the hormone aldosterone, the body begins to lose sodium, because of what the patients are heavily leaning on the salty. The level of glucose also drops sharply( there is not enough cortisol to even out the situation), therefore, at large breaks between meals, the muscles begin to tremble, the patient dramatically weakens. After a meal, with a new portion of glucose, the condition improves.

    Acute adrenal insufficiency begins with characteristic symptoms: weakness, low blood pressure, abdominal pain, nausea. The approaching Addisonian crisis is also signaled by a sharp pallor, a decrease in the amount of urine and a loose stool, seizures.

    The main symptoms of acute adrenal insufficiency

    Diagnosis

    The main diagnostic functional disorder of the adrenal glands is a low level in the blood of cortisol and aldosterone.

    Therefore, when suspected of hypokorticism, the first thing to do is to test for hormones. These are:

    • volume of cortisol and aldosterone in the blood;
    • the amount of 17-ACS and 17-CS( metabolites of cortisol) in the urine;
    • ACTH in the blood;
    • stimulation test with ACTH.

    Requires a general blood test( to detect metabolic disorders).

    Treatment of

    The basis for the treatment of any form of adrenal insufficiency is hormone replacement therapy.

    The patient is prescribed synthetic hormonal drugs:

    • cortisone;
    • hydrocortisone;
    • prednisolone;
    • dexamethosone;
    • fludrocortisone.

    Which medications from this list to choose and in what dosage, the doctor decides on the basis of the patient's condition, his age and the cause of the ailment. So, with an easy degree of pathology, it is enough to take cortisone, if the disease is at a more serious stage, a complex of "prednisolone - cortisone - fludrocortisone" is needed.

    The doctor monitors the progress of treatment every month, as soon as the patient's condition ceases to cause fear - once in 2-3 months. Drinking hormonal drugs for chronic hypofunction of the adrenal glands will have a lifetime.

    Acute hypocorticism requires immediate hospitalization and infusion therapy( glucose and sodium chloride) to prevent dehydration and hypoglycemia. On the first day the patient receives hydrocortisone intravenously and intramuscularly( the dosage depends on the patient's age), the next day the drug is administered only intramuscularly. When the condition stabilizes, you can transfer the patient to hormonal tablets.

    Complications of

    The most terrible complication of adrenal hypofunction is an acute attack of the disease, or Addison's crisis. Weakness, low blood pressure and severe dehydration in such a state threaten to result in collapse( acute vascular insufficiency) and fainting if the patient is not immediately hospitalized. The most terrible outcome is a coma and death of the patient.

    Symptoms of a crisis are the same as with chronic kidney hypofunction, they simply develop in the shortest possible time.

    Depending on which features are greatest, there are three variants of the Addison Crisis:

    1. Cardiovascular. The most noticeable violations of blood circulation: a strong pallor, low blood pressure, cold hands and feet, threadlike pulse, tachycardia and a decrease in the amount of urine.
    2. Gastrointestinal. Symptoms are similar to severe poisoning: spasms and painful pain in the abdomen, unbearable nausea with vomiting, bloody diarrhea.
    3. Neuropsychic. Here in the foreground - nerve disorders. This is a headache, seizures, delusions, stupor, etc.

    Forecasts and prevention

    The most ambiguous predictions are in the acute form of hypocorticism. Addison's crisis is difficult to stop, therefore it is very important not to admit such a situation in chronic adrenal lesions.

    There is no specific prevention of adrenal insufficiency. The best that the patient can and should do is to take medicines on time and correctly. All accompanying ailments( infections, gastrointestinal disorders, trauma) is important urgently and fully treated, the dosage of hormones during this period should be increased.

    So, if a patient has taken an infection or undergoes an operation, the dose of glucocorticoids should be increased 3-5 times. Mineralocorticoids should be drunk in the "old" volume.

    If you follow all the recommendations of a doctor and correctly carry out hormone replacement therapy, then the prognosis with adrenal patients will be quite favorable and the patient's quality of life will not suffer.

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