Insufficiency of the adrenal cortex is an acute and chronic. Chronic adrenocortical insufficiency may be primary or secondary.
Primary adrenalinsufficiency is the result of tissue destruction of the adrenal gland, secondary adrenocortical insufficiency is the result of violations of the hypothalamic-pituitary regulation (production of adrenocorticotropic hormone and pituitary kortikoliberina hypothalamus).
Secondary adrenocorticalinsufficiency occurs in diseases of the brain with a lesion of the pituitary or hypothalamus (a brain tumor, traumatic brain injury, after brain surgery, after radiation therapy for various intoxications).
Primary chronic adrenocortical insufficiency develops, if maintained and operated at least 10-15% of adrenal tissue. By the predisposing factors of Addison's disease include:
infectious diseases (syphilis, tuberculosis, fungal diseases of the adrenal glands)
amyloidosis of adrenal
Previously, the most common disease leading to chronic primary adrenal insufficiency, had tuberculosis. Now more than 80% of diseases are called autoimmune and - idiopathic atrophy of the adrenal cortex. In the body of as yet unknown reason, the system breaks down the immune control, and produced autoantibodies that destroy the cell's own adrenal glands.
During Addison's disease.
Primary adrenal insufficiency usually begin gradually. In the beginning there are complaints of weakness, fatigue, particularly in the evening. Sometimes this weakness occurs only after exercise or stressful situations. Deteriorating appetite, patients often suffer from colds. Appears poor tolerance of solar radiation, accompanied by a persistent tan.
In the course of Addison's disease muscle weakness becomes more pronounced. The patient is difficult to make any movement. Even his voice is quiet. Reduced body weight. Almost all patients appear resistant hyperpigmentation (increased skin coloration), especially in areas of friction of clothing, in open areas of the body exposed to sunburn, enhanced color nipples, lips, cheeks. There is a sustained reduction in blood pressure, increased heart rate. Appear disorders of the gastrointestinal tract: nausea, vomiting, constipation, diarrhea, alternated. Reduced the amount of glucose in the blood. Disrupted the kidneys, often manifested by nocturnal urination. The central nervous system disorders arise in attention, memory, depression. In women, due to lack of androgens fall pubic hair and armpits.
Diagnosis of primary adrenal insufficiency.
Diagnosis of Addison's disease is carried out on the basis of complaints and the appearance of the patient, persistent reduction in blood pressure, poor exercise tolerance. In the blood of patients exhibit:
reduction of cortisol
increase in potassium
elevated levels of corticotropin.
Treatment of primary adrenal insufficiency.
The treatment is to stimulate the synthesis of their own adrenal hormones and replacement therapy with corticosteroids. Assigned to a diet high in carbohydrates, plenty of salt, protein foods and vitamins, especially ascorbic acid. If the condition of patients is good, glucocorticoid replacement therapy may be administered only during periods of stress.
However, most of these patients require constant reception of glucocorticoids, in addition to some prescribed and mineralocorticoids. The main drug is hydrocortisone (cortisol, kortef). Less commonly used prednisolone, dexamethasone, triamcinolone.
The main principle of treatment of primary adrenal insufficiency is a sufficient designation of hormone replacement therapy to achieve compensation for illness, while trying not to overdose on medication.
If the patient is Addison's disease need surgery on any other organ, the operation is performed under the condition of intravenous hydrocortisone during surgery and in the postoperative period, the usual dose of hormones increases. Young women suffering from primary chronic deficiency may be pregnancy and childbirth, if taken by increasing the dose of hormones.
With early diagnosis and timely assignment of appropriate treatment of Addison's disease, the prognosis is favorable. However, patients may not engage in heavy physical labor, and should be aware that any stress effect may require larger doses taken hormones.