Directly above the kidneys is a paired organ in the shape of a triangle. Its mass is approximately 5 g. The main task of the adrenal glands is the synthesis of hormones that are vital for the human body. This process occurs in the cortex, but under the influence of various adverse factors, it is disturbed. In such cases, the doctor diagnoses "adrenal insufficiency". The course of the disease can be both acute and chronic.
General information and mechanism for the development of pathology
The adrenal glands consist of cortical and medulla layers. In this case, the latter is considered central and is responsible for the production of hormones, the task of which is to normalize blood pressure. But the diagnosis of "renal failure" is made only with a deficiency of certain substances synthesized in the cortical layer, namely aldosterone and cortisol.
The first is necessary to maintain a normal balance of bicarbonates, sodium, chloride and potassium.
Cortisol is responsible for the following processes:
- maintaining carbohydrate metabolism;
- acceleration of calcium excretion inblood, reducing the degree of its absorption by bone tissue;
- participation in the breakdown of proteins from amino acids;
- increasing the deposition of fat under the skin of the face and trunk, burning it on the limbs;
- eliminate inflammation.
The production of hormones is controlled not only by the adrenal glands, but also by the pituitary and hypothalamus. These are the organs of the endocrine system, which are located in the skull. The process occurs as follows: the hypothalamus produces corticoliberin, then this substance enters the pituitary gland and promotes the synthesis of ACTH (adrenocorticotropic hormone), which, in turn, has a direct effect on the work of the adrenal glands. Failure develops when a violation occurs at any stage. Another name for the pathology is hypocorticism.
Disease classification
Since the process of hormone production is triple regulated, their level may decrease due to disruption of one of the organs.
In endocrinology, adrenal insufficiency is divided into the following types:
- Primary. It is characterized by damage directly to the paired organ.
- Secondary. Occurs against the background of the development of diseases of the pituitary gland, which as a result produces an insufficient amount of ACTH or does not synthesize it at all.
- Tertiary. It is characterized by the production of a small amount of corticoliberin in the hypothalamus.
Primary adrenal insufficiency is considered the most severe form of the disease.
In some casespathology develops against the background of normal synthesis of aldosterone and cortisol. This is due to the low sensitivity of receptors to these substances.
According to the nature of the course of the disease, it can be:
- Sharp. Adrenal insufficiency in this case is also called an Addisonian crisis. With this form of pathology, the patient must be provided with emergency assistance, otherwise the disease may be fatal.
- Chronic. Adrenal insufficiency in such cases can have several stages. With a chronic disease, patients can live for many years if they visit their doctor regularly to adjust the therapeutic regimen.
Reasons
The adrenal glands are an organ with good compensatory capabilities. But under the influence of provoking factors, a serious failure may occur in their work.
Primary adrenal insufficiency is caused by the following diseases and conditions:
- Pathologies of an autoimmune nature. More than 90% of cases of hypocorticism are associated with an attack by antibodies of the cells of one's own body.
- Underdevelopment of the adrenal cortex. The anomaly is congenital.
- Allgrove's syndrome. This is a condition characterized by resistance to ACTH.
- Tuberculosis.
- Amyloidosis. The development of this pathology is accompanied by the deposition in the adrenal glands of an excessive amount of protein formed against the background of a long course of a chronic disease.
- Adrenoleukodystrophy. This is a pathologyof a hereditary nature, in which an excessive amount of fatty acids accumulate in the body, provoking the occurrence of disorders in the work of the adrenal glands and some parts of the brain.
- Tumor metastases in malignant diseases.
- Hemorrhage in the adrenal glands. As a rule, it occurs due to serious infectious pathologies: meningitis, scarlet fever, sepsis, diphtheria.
- Thrombosis of the vessels through which the adrenal glands are nourished.
- Malignant neoplasms in the organ itself.
- Human immunodeficiency virus, which causes necrosis of the tissue of the adrenal glands.
- Kearns Syndrome. It is characterized by damage to the muscles and eye tissue.
- Smith Syndrome - Opica. It is a combination of several pathologies at once: a violation of mental development, a small volume of the cranium, anomalies in the structure of the genitals.
In newborns, adrenal insufficiency may be the result of hypoxia that occurs during childbirth.
Causes of the secondary form of the disease:
- Pathologies of an infectious nature.
- Hemorrhage that developed as a result of some kind of injury.
- Malignant neoplasms in the pituitary gland.
- Autoimmune diseases.
- Destruction of the pituitary gland. In most cases, it occurs against the background of radiation, surgery or long-term therapy with glucocorticoid drugs.
- Congenital pathologies of the pituitary gland, in which the mass of the organ is less than normal.
Tertiary form of the disease alsocan be either hereditary or acquired. It can appear due to malignant neoplasms of the hypothalamus, its radiation, hemorrhage into the organ, pathologies of an infectious nature.
Symptoms
The severity of symptoms depends on the rate of damage to the tissues of the adrenal glands. If they die very quickly, an Addisonian crisis develops, slowly - chronic hypocorticism.
Acute adrenal insufficiency has the following symptoms:
- paleness of the skin that occurs suddenly, while the fingertips become bluish;
- greatest weakness;
- palpitations;
- vomit;
- pain in the abdomen, not having a specific localization;
- frequent episodes of diarrhea;
- rare urge to urinate.
Some patients experience muscle cramps. In addition, if the cause of the disease is a meningococcal infection, a black-brown rash is added to the above symptoms of adrenal insufficiency. When pressed on the skin with transparent glass, it does not disappear.
Adrenal insufficiency in children can develop against the background of the usual SARS, vaccination, intestinal diseases, stressful situations. In addition, babies born from a breech presentation or with hypoxia are at risk. Symptoms of adrenal insufficiency in young children are the same as in adults.
Acute disease in most casesdevelops without any previous warning signs. With a sharp deterioration in well-being, it is necessary to call an ambulance. In the absence of timely intervention by doctors, the patient falls into a coma, which often ends in death.
In both men and women, the symptoms of chronic adrenal insufficiency appear after being in a stressful situation. As provoking factors may be: psycho-emotional instability, various injuries, infectious diseases.
Chronic adrenal insufficiency has the following symptoms:
- Increased pigmentation of the skin and mucous membranes. This condition occurs with primary hypocorticism. And with secondary adrenal insufficiency, and with tertiary, staining of the mucous membranes and skin never occurs. First of all, those areas that are least likely to be covered by clothing (neck, face, palms), as well as areas that always have a darker shade (scrotum in men, armpits, perineum, nipple areola) begin to darken. In addition, the mucous membranes of the cheeks, tongue, gums, vagina and rectum are stained. The degree of hyperpigmentation in adrenal insufficiency directly depends on the duration of the pathology. It can be both light, reminiscent of a tan, and pronounced, manifesting itself in dark areas and creating the effect of very dirty skin. With the autoimmune nature of primary hypocorticism, vitiligo spots appear on the stained areas.(completely depigmented areas).
- Weight loss. This is due to a significant lack of nutrients in the body. At the same time, a person can lose both a small amount of kilograms and more than 15, which leads to malnutrition.
- Behavioral disorders. With the development of primary hypocorticism, patients complain of: constant irritability, apathy, pronounced muscle weakness, depression. Against the background of these states, both partial and complete loss of working capacity occur.
- Digestive disorders. Characteristic signs of primary chronic adrenal insufficiency are: lack of appetite; nausea; pain in the abdomen, not having a clear localization; anorexia; vomit; alternating diarrhea and constipation.
- Lower blood pressure. A feature of the disease is a decrease in the rate by 5-10 mm Hg. At the same time, patients assess their condition as satisfactory.
- Cravings for s alty foods, trembling muscles and weakness on an empty stomach. These states disappear after a meal. With secondary adrenal insufficiency, patients do not feel cravings for s alty foods. Weakness and trembling occur several hours after eating.
In addition, in women, a symptom of adrenal insufficiency is a decrease in libido and a cessation of body hair growth.
Parents should take their child to the doctor if they have: drowsiness, vomiting without any reason, cravings for s alty foods. If, against the background of these states,darkening of scars, folds, mucous in the oral cavity, this indicates the presence of chronic adrenal insufficiency.
Diagnosis
The doctor may suspect the presence of pathology already during the interview and examination of the patient.
To confirm the diagnosis and determine the form of the disease, the specialist prescribes the following laboratory tests:
- Blood test. The doctor is interested in the level of cortisol (in case of insufficiency, it is always reduced), ACTH (in the primary form, its indicator increases, in other cases it decreases), aldosterone.
- Urine analysis. The development of the disease is accompanied by a decrease in cortisol metabolites in the primary and secondary forms of pathology.
As indicated, a stimulation test may be ordered. Its essence is as follows: blood is taken from the patient and the level of cortisol in it is determined. He is then injected with synthetic ACTH. A second study is carried out after 30 and 60 minutes. Normally, the level of cortisol increases at least 4 times. If its level is lower, this indicates the presence of adrenal insufficiency. The test is performed at 08:00, as it is at this time that the greatest activity of the necessary hormones is observed.
In addition, the doctor prescribes an examination using instrumental methods:
- Ultrasound of the adrenal glands. If imaging is difficult, the patient is referred for a CT scan.
- MRI of the brain. During the study, the state of the pituitary gland and hypothalamus is assessed.
Based on the results of laboratory and instrumental diagnostics, the doctor can make an accurate diagnosis and determine which form of the disease the patient suffers from (primary, secondary or tertiary). After that, it is necessary to find out the degree of violation of metabolic processes. To do this, the patient must donate blood for a general analysis. In addition, an electrocardiogram is mandatory. This study allows you to assess the state of the heart and how much changes in the electrolyte composition of the blood affected its work.
Diagnosis of the disease in children is carried out in the same way as in adults.
Treatment
In the event of an attack of acute adrenal insufficiency, you must immediately call an ambulance. Upon arrival at the hospital, the patient is immediately placed in the intensive care unit.
Treatment for adrenal insufficiency in these cases includes:
- Administration of large amounts of glucose and saline intravenously. This is necessary to normalize the water and electrolyte balance. At the same time, sodium and potassium levels in the blood are constantly monitored.
- Intravenous administration of synthetic hormones. In most cases, "Prednisolone" ("Hydrocortisone" in young children) is used for this purpose. After the body recovers from the state of shock, the drug is administered intramuscularly.
- Normalization of blood pressure. With a significant decrease in the rate, the patient is injected with Mezaton, Dobutamine, Adrenaline or Dopamine.
- Eliminationpathology that provoked the attack. For this, both conservative and surgical methods of treatment can be used.
After stopping the attack, the patient is transferred to the general ward.
According to clinical guidelines, in case of chronic adrenal insufficiency, the patient must be injected with synthetic glucocorticoids. A mild degree of the disease is corrected by the drug "Cortisone". If the pathology is pronounced, the doctor additionally prescribes "Prednisolone" and "Fludrocortisone". The latter is an analog of the mineralcorticoid aldosterone.
This combination is due to the fact that it is impossible to carry out treatment with glucocorticoids alone. Otherwise, adults feel significantly worse, and children experience poor weight gain, dehydration, mental retardation.
Monitoring the patient's he alth is carried out monthly, after the normalization of all necessary indicators - 4 times a year. If necessary, adjustments are made to the treatment regimen.
Features of food
Diet for adrenal insufficiency plays an important role.
Correction of the diet is carried out in accordance with the following principles:
- The calorie content of meals should be increased by 25%.
- You need to get enough animal protein in your body. To do this, fish and meat must always be present on the menu.
- It is recommended to give preference to easily digestible carbohydrate food. To replenish the level of fat, you must regularly include butter in the menu.
- The amount of table s alt can be left the same. It is necessary to reduce the consumption of prunes, apricots, figs, raisins to a minimum and exclude bananas and baked potatoes from the diet. This is due to the need to limit the intake of potassium s alts in the body.
- It is forbidden to eat fried food. Such dishes contain toxic compounds that create an additional burden on the internal organs.
- The menu should contain fresh juices, berries and fruits daily.
Often, against the background of adrenal insufficiency, patients develop gastric and duodenal ulcers. In the presence of this pathology, the doctor adjusts the diet.
Consequences
Against the background of aldosterone deficiency, dehydration occurs. This condition gradually progresses as sodium continues to be lost in large amounts. At the same time, there is an excess accumulation of potassium. The natural result is a failure in the functioning of the organs of the digestive system. In addition, the work of the heart is disrupted. When potassium rises to a level of 7 mmol / l, it may stop.
Lack of cortisol is dangerous because glycogen production is disrupted. This substance is the main storage form of glucose in the liver. With its deficiency in the pituitary gland, the process of increased production of ACTH is launched, which as a result provokes the synthesis of not only cortisol, but alsomelanotropin. The latter is the cause of hyperpigmentation of the skin and mucous membranes.
Prevention
The Addisonian crisis is almost impossible to prevent. When it appears, the main condition for a successful prognosis is timely medical care.
Prevention of chronic adrenal insufficiency consists in the implementation of maintenance therapy, which, in turn, is based on the use of synthetic hormones. The dosage and scheme are calculated only by the attending physician on an individual basis. If you feel worse, the specialist makes adjustments to the appointments.
In closing
The adrenal glands are a paired organ that produces vital substances. Under the influence of various adverse factors, the process of hormone production is disrupted. Against the background of cortisol and aldosterone deficiency, adrenal insufficiency develops.
The disease can have several forms: primary, secondary and tertiary. The first is considered the most dangerous, since it is she who is associated with the defeat of the adrenal glands themselves. In other cases, the work of the pituitary gland and hypothalamus is disrupted.
Pathology can also have both acute and chronic course. In the first case, you must immediately call an ambulance. This is due to the fact that such a condition without timely intervention leads to death. The chronic form is treated with synthetic hormones.
