Adrenal gland hypofunction

Overview

The adrenal gland produce hormones that affect various functions in the body. Some of these hormones are cortisol, aldosterone and androgens such as testosterone. When the adrenal glands are underactive or in a state of hypofunction, they produce low amounts of these hormones. Adrenal hypofunction, also called adrenal insufficiency, is caused by several conditions including autoimmune disease. Treatment for adrenal hypofunction is available once its symptoms are correctly recognized.

Symptoms

  • Weakness
  • Dizziness
  • Fatigue
  • Weight loss
  • Abdominal discomfort
  • Increased skin pigmentation
  • Mental problems
  • Depression
  • Muscle pain
  • Joint pain
  • Dehydration
  • Gastrointestinal disturbances
  • Anxiety
  • Restlessness
  • Emotional distress
  • Reduced tolerance to physical stress
  • Reduced tolerance to emotional stress
  • Reduced blood sodium
  • Reduced blood glucose
  • High blood potassium
  • Tremors
  • Reduced blood pressure
  • Fainting

Causes

Adrenal hypofunction occurs when more than 90% of both adrenal glands are destroyed, an occurrence that typically results from an autoimmune process in which circulating antibodies react specifically against the adrenal tissue. Other causes include tuberculosis (once the chief cause; now responsible for less than 10% of adult cases), bilateral adrenalectomy, hemorrhage into the adrenal gland, neoplasms, and infections (acquired immunodeficiency syndrome, histoplasmosis, and cytomegalovirus). Rarely, a familial tendency to autoimmune disease predisposes the patient to adrenal hypofunction and other endocrinopathies. Secondary adrenal hypofunction that results in glucocorticoid deficiency can stem from hypopituitarism (causing decreased corticotropin secretion), abrupt withdrawal of long-term corticosteroid therapy (long-term exogenous corticosteroid stimulation suppresses pituitary corticotropin secretion and results in adrenal gland atrophy), or removal of a nonendocrine, corticotropin-secreting tumor. Adrenal crisis follows when trauma, surgery, or other physiologic stress exhausts the body’s stores of glucocorticoids in a person with adrenal hypofunction. Adrenal hypofunction affects 1 in 16,000 neonates congenitally. In adults, it affects 8 in 100,000 people, and males and females are affected equally. There’s no racial predilection.

Diagnosis

The best diagnostic tool to confirm adrenal insufficiency is the ACTH stimulation test; however, if a patient is suspected to be suffering from an acute adrenal crisis, immediate treatment with IV corticosteroids is imperative and should not be delayed for any testing, as the patients health can deteriorate rapidly and result in death without replacing the corticosteroids.

Treatment

Treatment of adrenal hypofunction or the resulting adrenal insufficiency involves replacing deficient adrenal hormones with synthetic ones. Hydrocortisone is a medication that doctors use to replace cortisol, whereas fludrocortisone is used to replace aldosterone.