Adrenal disorders

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Overview

Adrenal glands, which are also called suprarenal glands, are small, triangular glands located on top of each kidney. An adrenal gland is made of 2 parts: the outer region, called the adrenal cortex, and the inner region, called the adrenal medulla. The adrenal glands work interactively with the hypothalamus and pituitary gland to secrete hormones that affect metabolism, blood chemistry, and some physical characteristics. Adrenal glands also secrete hormones that help a person cope with both physical and emotional stress.

Hormones secreted by the adrenal glands include:

Adrenal cortex:

Corticosteroid hormones (cortisol). Help control the body's metabolism of fats, proteins, and carbohydrates, suppress inflammatory reactions in the body, and affect the immune system function.

Aldosterone. Maintains blood volume and blood pressure by inhibiting the amount of sodium excreted into the urine.

Androgenic steroids (androgen hormones). Affect the development of pubic and underarm (axillary) hair, and production of adult body odor.

Adrenal medulla:

Epinephrine (adrenaline). Increases the heart rate and force of heart contractions, facilitates blood flow to the muscles and brain, relaxes smooth muscles in arteries, converts starch to simple sugar in the liver, and other activities.

Norepinephrine (noradrenaline). Increases blood pressure through strong vasoconstrictive effects (narrowing of the blood vessels), but exerts little effect on smooth muscles, metabolic processes, and cardiac output.

Certain adrenal gland disorders are characterized by an inability of the adrenal glands to produce cortisol and aldosterone, often due to certain missing enzymes (substances that speed up or cause chemical reactions). With the most common defects in adrenal synthetic pathways, intermediate chemicals may be diverted within the adrenal gland to produce excessive androgens, which can lead to masculinization of affected females.


Symptoms

Addison's disease symptoms usually develop slowly, often over several months. Often, the disease progresses so slowly that symptoms are ignored until a stress, such as illness or injury, occurs and makes symptoms worse. Signs and symptoms may include:


Extreme fatigue

Weight loss and decreased appetite

Darkening of your skin (hyperpigmentation)

Low blood pressure, even fainting

Salt craving

Low blood sugar (hypoglycemia)

Nausea, diarrhea or vomiting (gastrointestinal symptoms)

Abdominal pain

Muscle or joint pains

Irritability

Depression or other behavioral symptoms

Body hair loss or sexual dysfunction in women

Acute adrenal failure (addisonian crisis)

Sometimes the signs and symptoms of Addison's disease may appear suddenly. Acute adrenal failure (addisonian crisis) can lead to life-threatening shock. Seek emergency medical treatment if you experience the following signs and symptoms:

Severe weakness

Confusion

Pain in your lower back or legs

Severe abdominal pain, vomiting and diarrhea, leading to dehydration

Reduced consciousness or delirium

In an addisonian crisis you will also have:

Low blood pressure

High potassium (hyperkalemia) and low sodium (hyponatremia)

Causes

Adrenal gland disorders are caused by problems with the glands themselves that cause overproduction or underproduction of hormones. They are also caused by problems in other glands, such as the pituitary gland. Genetics can also play a part in certain adrenal disorders.Primary adrenal insufficiency is most often caused when your immune system attacks your healthy adrenal glands by mistake. Other causes may include: Cancer. Fungal infections.

Adrenal gland disorders are caused by problems with the glands themselves that cause overproduction or underproduction of hormones. They are also caused by problems in other glands, such as the pituitary gland. Genetics can also play a part in certain adrenal disorders. In many cases, no one really knows why the disorders develop.

Adrenal gland disorders are caused by problems with one or both adrenal glands or by problems with other glands, such as the pituitary gland.

Specific disorders can develop when the adrenal glands produce too few or too many hormones, or when too many hormones are introduced from an outside source.

Risk factors

In many cases, the causes for adrenal disorders aren’t known. However, some types of adrenal disorders are linked to genetics. Others may result more frequency if you have to take or choose to take certain types of drugs, such as steroids. Steroids are used to treat many types of diseases, but you should always be aware of their many side effects.

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Complications

With adrenal insufficiency, the inability to increase cortisol production with stress can lead to an addisonian crisis. An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium. You will need immediate medical care.

If not treated, adrenal insufficiency may lead to:

Severe belly (abdominal) pain.

Extreme weakness.

Low blood pressure.

Kidney failure.

Shock.

Prevention

Addison's disease can't be prevented, but there are steps you can take to avoid an addisonian crisis:

Talk to your doctor if you always feel tired, weak, or are losing weight. Ask about having an adrenal shortage.

If you have been diagnosed with Addison's disease, ask your doctor about what to do when you're sick. You may need to learn how to increase your dose of corticosteroids.

If you become very sick, especially if you are vomiting and you can't take your medication, go to the emergency room.

Some people with Addison's disease worry about serious side effects from hydrocortisone or prednisone because they know these occur in people who take these steroids for other reasons.

However, if you have Addison's disease, the adverse effects of high-dose glucocorticoids should not occur, since the dose you are prescribed is replacing the amount that is missing. Make sure to follow up with your doctor on a regular basis to make sure your dose is not too high.