Hypothyroidism and hyperfunction of the adrenal cortex are diseases of the adrenal cortex. One of them is manifested by decreased secretion of adrenal steroid hormones, and the other is mainly due to the presence of a phaeochromocytoma. Treatment depends largely on the cause and does not guarantee full recovery, sometimes it is necessary to supplement the hormones for the rest of their lives.
Adrenal insufficiency
What is hypothyroidism?
Adrenal insufficiency leads to a reduction in the secretion of adrenal steroid hormones. Clinical symptoms, such as weakness, skin hyperpigmentation, hypotonia, may be accompanied by delayed sexual maturation, later onset of menarche, and later in life – oligomenorrhoea-like menstrual disorders, and even secondary amenorrhea. As a result of the reduction of androgen secretion, libido decreases and secondary and tertiary sexual characteristics disappear. Hormonal tests always show: low levels of cortisol and ACTH (in secondary hypoadrenocorticism) or high levels of ACTH in primary adrenal insufficiency.
The causes of adrenal insufficiency
An insufficiency of the adrenal cortex may result from damage to the adrenal gland (primary hypothyroidism – Addison’s disease) or from an abnormal pituitary gland (secondary insufficiency of the adrenal cortex). This ailment is rare, in about 60% of patients a secondary form of the disease can be observed.
The main causes of primary adrenal insufficiency include:
- autoimmune inflammation of the adrenal cortex (slowly destroys the organ);
- tuberculosis (less common factor).
In contrast, the main causes of secondary adrenal insufficiency are:
- long-term use of glucocorticosteroids in high doses;
- injuries and tumors in the hypothalamic-pituitary area.
Symptoms of adrenal insufficiency
Symptoms depend on the cause of the hypoadrenocorticism, for example in the secondary form the symptoms are less noticeable. The rate at which the hormone deficiency occurs and the degree of this deficiency is also important. In addition, a life-threatening adrenal crisis may occur, during which the patient should be given hydrocortisone as soon as possible. Symptoms of a developed crisis are: fever, impaired consciousness, low blood pressure, and loss of consciousness.
Other characteristic symptoms of adrenal insufficiency include:
- tiredness,
- abdominal pain,
- lack of appetite
- weight loss
- vomiting,
- nausea,
- weakness,
- you want salty foods more,
- hypoglycaemia – that is, low blood sugar,
- low amount of sodium in the blood and / or high amount of potassium in the blood
- darkening of the skin – Addison’s disease,
- pale skin – secondary adrenal insufficiency,
- low blood pressure, which may cause you to faint when you sit down / stand up quickly from a lying position.
Diagnosis of adrenal insufficiency
The patient is referred to special hormonal tests to confirm the diagnosis. These include morning blood levels of cortisol and ACHT. The time in this case is very important because in healthy patients the level of cortisol changes during the day (the highest is in the morning and the lowest in the evening and at night). Patients with lowered cortisol and elevated ACHT levels have primary hypothyroidism. On the other hand, patients with lowered cortisol levels, and normal or lowered ACHT – have secondary hypothyroidism. There are cases where the diagnosis of the disease is quite difficult and additional stimulatory tests must be performed.
After the diagnosis of adrenal insufficiency, the doctor looks for the cause. There are indications for imaging in the form of magnetic resonance imaging of the pituitary gland or ultrasound and computed tomography of the adrenal glands, it depends on the established diagnosis.
Treatment of adrenal insufficiency
Treatment of adrenal insufficiency is substitutive and consists in replenishing the missing hormones. In the primary form of hypothyroidism, glucocorticosteroids are used mainly, sometimes androgens, and in most cases mineralocorticosteroids. For secondary hypothyroidism, treatment consists of glucocorticosteroids and androgens.
In the case of secondary adrenal insufficiency, the pituitary-adrenal gland may continue to function as before, after long-term treatment with glucocorticoids taken for other diseases, months after discontinuation of high doses of glucocorticoids. In some patients, treating the underlying causes causes the symptoms of adrenal insufficiency to subside (e.g., after surgery for a tumor that compresses and causes hypopituitarism). Unfortunately, in most cases it is impossible to cure adrenal insufficiency and substitution treatment is necessary for the rest of life. The patient can function well if he remembers to replenish hormone deficiencies.
How to reduce the risk of falling ill?
Here are some steps you can take to help lower your risk of adrenal insufficiency.
1. Avoid smoking. This will help reduce the risk of cancer, which often spreads to the pituitary and adrenal glands.
2. The risk of iatrogenic pituitary damage may be reduced through continuous refinement of radiotherapy methods and neurosurgical techniques.
3. Also prophylactic vaccinations (eg against tuberculosis) and prompt diagnosis and implementation of tuberculosis treatment may reduce the risk of adrenal gland damage and complications.
Overactive adrenal cortex
An overactive adrenal cortex is a condition that causes the amount of hormones produced by the adrenal glands to cause negative symptoms. The adrenal gland in the cortical part produces cortisol as well as aldosterone and androgens, while the gland in the medullary part produces adrenaline. If too much cortisol is produced, Cushing’s syndrome occurs, and if aldosterone is produced, it causes hyperaldosteronism. An overactive adrenal cortex is most often caused by a phaeochromocytoma.
Cushing’s syndrome
Too much cortisol in the body is the most common cause of Cushing’s syndrome. This may be due to the use of a large amount of corticosteroid drugs that act in the same way as cortisol. This type of preparation is most often prescribed to patients who struggle with asthma, arthritis or lupus.
It is not uncommon for steroid doses to significantly exceed the body’s cortisol levels, and steroid-induced hyperfunction is called iatrogenic Cushing’s syndrome, which is a complication of injectable or oral corticosteroids. Taking this group of drugs in the form of ointments or inhalers is less of a risk.
What influences the excessive production of cortisol (overactive adrenal cortex)?
- the ailment may result from spontaneous hyperfunction of the adrenal gland (the gland itself produces too much cortisol);
- primary adrenal disease – sometimes these are rare adrenal tumors that produce cortisol;
- a familial history of Cushing’s syndrome – caused by a rare genetic defect that leads to an increased risk of endocrine cancer;
- pituitary cancer – a benign tumor of the pituitary gland that secretes substances that control other glands, such as the hormone ACHT, which in turn stimulates the adrenal glands to work. Pituitary cancer (pituitary adenoma) is the most common cause of adrenal hyperfunction;
- ectopic cancer – characterized by a condition in which the hormone-producing gland is located somewhere else than it should be, yet is active and continues to produce cortisol;
- ACHT-producing ectopic tumor – sometimes this type of tumor appears in another organ that does not have the ability to secrete ACHT. It can be benign or malignant, mainly in the thyroid gland, thymus, spleen and lungs.
Symptoms of an overactive adrenal cortex
The symptoms that indicate Cushing’s syndrome are very different:
- a large increase in weight is characteristic, especially in the area of the face, neck and abdomen;
- pink or purple stretch marks on the abdomen, arms and thighs;
- high blood pressure;
- muscle weakness;
- general fatigue;
- there is also depression, irritability, aggression, problems with emotions;
- the skin becomes very fragile, which leads to more frequent damage and bruising;
- wounds heal very slowly, even after an ordinary insect bite;
- osteoporosis;
- the need to urinate frequently;
- increased thirst;
- glucose intolerance which may result in diabetes mellitus;
- in women, menstrual periods may be disturbed or absent altogether;
- female hair may be thicker and darker;
- acne;
- in men, libido may decrease, and erectile dysfunction and fertility may be impaired;
- an overactive adrenal cortex in children makes them more obese than their peers.
Diagnosis of an overactive adrenal cortex
The diagnosis of an overactive adrenal cortex (Cushing’s syndrome) can be a problem due to its specific symptoms. Symptoms in this ailment may be confused with other diseases, such as hypertension or hypothyroidism. The doctor makes the diagnosis on the basis of the medical history, general examination and other additional tests. Daily urine and blood tests are performed to help determine your cortisol levels. In addition, special tests are recommended to determine the source of excess cortisol – for this purpose, a blood test is performed before and after the administration of preparations that stimulate or inhibit certain functions of the endocrine system. Cortisol can even be tested for saliva. In some cases (suspected cancer), additional imaging examinations in the form of ultrasound or computed tomography should be performed.
Treatment of Cushing’s syndrome
Treatment is aimed at lowering the level of cortisol in the body, and its form depends on the very cause of the disease. Causes and Treatment:
- taking corticosteroids – symptoms will improve as the dose is reduced or the drug is completely discontinued. Attention! Do not stop the treatment yourself without consulting your doctor! This can have the opposite effect;
- cancer – it can be excised, tumors usually require surgery by a neurosurgeon. After tumor excision, patients have to supplement the missing substances for a certain period of time. The dose is then gradually lowered until the body begins to produce the correct amount of hormones on its own again. It may take up to a year, and some patients do not regain their former fitness at all and have to supplement the missing hormones for the rest of their lives;
- inoperable tumors – radiotherapy is used, which gives very good results;
- Other treatments have failed – cortisol-lowering medications, such as ketoconazole, may be given prior to surgery to improve the patient’s health.
CONNA TEAM
This is another type of overactive adrenal gland (also called hyperaldosteronism) and is caused by the production of large amounts of aldosterone – the second hormone, in addition to cortisol, that is produced by the cortex of the adrenal gland. Conn’s syndrome manifests itself mainly by high blood pressure, without a drop in potassium levels or heart problems. This ailment can cause:
- constant fatigue,
- muscle fatigue due to low levels of potassium in the body,
- high blood pressure due to water retention in the body,
- disturbances in urine output and its concentration (there is also increased thirst),
What are the causes of Conn’s syndrome?
The causes are similar to those of Cushing’s syndrome (apart from an over-supply of the hormone). The most common cause is an overgrowth of the glomerular layer that produces aldosterone. Usually it is mild, while adrenal adenoma causes an additional decrease in potassium, which is a dangerous situation. The main treatment for Conn’s syndrome consists of surgical removal of adrenal tissue or taking medications that inhibit the action of aldosterone.
Source: A. Cajdler-Łuba, S. Mikosiński, A. Sobieszczańska-Jabłońska, I. Nadel, I. Salata, A. Lewiński: “FUNCTIONAL DIAGNOSTICS OF HORMONAL DISORDERS WITH ELEMENTS OF DIFFERENTIAL DIAGNOSTICS; Czelej Publishing House