Adrenal insufficiency - What you need to know

The article is written by Master, Doctor Tran Quynh Trang - Doctor of Biochemistry - Laboratory Department - Vinmec Times City International Hospital.

With proper treatment, and additional precautions, adrenal insufficiency can lead to an active life, and a normal life expectancy.

The adrenal gland is a small but very important endocrine gland, secreting many hormones. The adrenal gland is triangular in shape, lying face down at the upper pole of the kidney, 2-4cm high, 3-5cm wide, weighing about 5-6 g. Consists of two parts: the cortex and the adrenal medulla. The adrenal cortex has 3 layers: the outermost layer is the globular layer, the middle layer is the bundle layer, and the innermost layer is the reticular layer. The glomerulus layer secretes mineralocorticoid, the bundle layer secretes Glucocorticoid, the reticulum secretes sex hormones. The pink adrenal medulla secretes catecholamines.

Adrenal insufficiency (AI) is a disorder characterized by impaired adrenal cortex function primarily resulting in decreased glucocorticoid and mineralocorticoid secretion. The hormone is important for homeostasis.

Causes of adrenal insufficiency are divided into 2 types:

Autoimmune adrenalitis, infection, adrenal infarction or hemorrhage, bilateral adrenal destruction, infiltrates, invasive cancer of the adrenal gland, adrenocortical leukodystrophy, adrenocortical insufficiency familial substance, corticosteroid-resistant syndrome, drugs that reduce cortisol synthesis such as ketoconazole, aminoglutethimide...

Due to taking high doses of glucocorticoids for a long time ... is the most common cause, in addition, adrenal insufficiency due to damage to the hypothalamus or pituitary gland such as postpartum pituitary necrosis, blood loss, tumor, inflammation, infection , autoimmune, granulomatous infiltration, trauma, atrophy, surgery, radiation therapy...

Clinical manifestations of the deficiency of glucocorticoids, corticosteroids and androgens of chronic primary adrenal insufficiency:
Fatigue: Physical, mental and sexual. Gradually thin due to dehydration, loss of salt, poor appetite. Digestive disorders: Abdominal pain, vomiting, nausea, diarrhea. Darkening of the skin (only in primary adrenal insufficiency): open areas, sun-exposed areas, scars, face, neck, hand folds, nipples, darkening of the cheeks, gums, tongue, and floor of the mouth. .. Hypoglycemia, cramps, salt cravings...

Occurs on the background of chronic adrenal insufficiency with increased corticosteroid requirements such as: severe infection, acute stress or bilateral adrenal hemorrhage, abrupt cessation of corticosteroids, patients with pituitary disease, history of tumor surgery pituitary... should think of acute adrenal insufficiency. Unexplained fever and pulse collapse due to other medical conditions. Neurological or psychiatric symptoms due to hypoglycemia, hyponatremia, dehydration such as: weakness, agitation, confusion, hyperthermia, muscle pain, cramps,...
Situation of acute gastroenteritis such as nausea, vomiting, or acute abdominal pain.

Quantification of hormones:
Plasma Cortisol (8am): normal 83-540 nmol/l.
Cortisol decrease < 83 nmol/l: confirm the diagnosis of adrenal insufficiency. Cortisol elevation > 540 nmol/l: exclude adrenal insufficiency. Aldosteronism: normal 140-690 nmol/24h, in primary adrenal insufficiency low and difficult to quantify.
Adrenal cortex hormone (ACTH) normal < 11 pmol/l
ACTH increased > 55.5 pmol/l: primary adrenal insufficiency ACTH decreased < 4.4 pmol/l: secondary adrenal insufficiency considered a giant sympathetic ganglion secreting catecholamines, in response to nerve impulses along the sympathetic preganglionic fibers to the adrenal medulla, causing increased activity of the sympathetic nervous system.
Epinephrine, norepinephrine and dopamine are called catecholamines. Normally, blood is 80% epinephrine and 20% norepinephrine.
Since adrenal insufficiency is caused by dysfunction of the cortex, the adrenal medulla is not affected. Adrenal insufficiency due to tuberculosis results in an enlarged adrenal gland in the presence of granulomas. The adrenal medulla is usually not grooved, and the gland is characterized by diffuse calcification.
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