Adrenal Insufficiency

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The adrenal glands sit atop the kidneys. They are very small, but their functions are immense. The inner portion of each gland, or adrenal medulla, produces and stores adrenaline, the fight-or-flight hormone. The outer portion, or adrenal cortex, has three separate areas. One area secretes aldosterone, which helps to control the balance of the body's electrolytes by helping the kidneys retain sodium and excrete potassium. If aldosterone levels fall, the kidneys may become unable to regulate the body's salt and water balance, resulting in a drop in blood volume and blood pressure. Another area of the adrenal glands manufactures sex hormones, or androgens. Possibly most important is the area that manufactures cortisol, the body's natural cortisone. This hormone which belongs to a class of hormones called glucocorticoids has a multitude of purposes. Its most important job is to assist the body in dealing with stress. It also regulates the metabolism of carbohydrates, maintains adequate blood pressure, and controls the body's response to injury and the process of tissue repair. Obviously, if the adrenal glands become weakened or injured and cannot function properly, a multitude of problems may result.

Weakness of the adrenal cortex that comes on suddenly and rapidly can be life-threatening. This situation is called, appropriately, adrenal crisis. It can occur as a result of serious stress or trauma, whether from direct injury, surgery, a tumor, or abrupt cessation of high-dose cortisone therapy, and is most likely to occur in individuals whose adrenal glands are already somewhat weak. It can also occur if a person with weak adrenals takes thyroid medication. Symptoms of adrenal crisis include low blood pressure with high fever, extreme weakness, confusion, sluggishness, nausea, vomiting, diarrhea, headache, and severe abdominal and/or lower back pain. This situation requires emergency treatment.

Less severe but chronic weakness of the adrenal glands is called Addison's disease. This is a rare disorder that affects about 1 in 100,000 people. It occurs in all age groups and afflicts men and women in equal numbers. Symptoms may include low blood pressure, weakness, weight loss, loss of appetite, nausea, vomiting, nervousness, and irritability. Joint and muscle paints are common, and the skin in many areas of the body may develop hyper pigmentation. Also, since cortisol regulates carbohydrates metabolism by counteracting the effects of insulin, low cortisol levels can result in bouts of low blood sugar. Some people with Addison's disease have symptoms all the time; others seem to be fine most of the time, but develop symptoms when they are under stress.

Adrenal insufficiency is diagnosed on the basis of symptoms and blood tests to measure the levels of adrenal hormones. Since the symptoms of Addison's disease are similar to ones caused by other disorders, including anorexia nervosa, gastrointestinal disease, and even hidden cancers, those possibilities must be ruled out before a firm diagnosis can be made. There is some question in conventional medicine as to whether it is possible to have chronic sub clinically weak adrenal function that is, adrenal insufficiency that is not severe enough to be detected by conventional testing, but that can nevertheless cause symptoms.

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