Understanding Adrenal Insufficiency
Adrenal insufficiency is a medical condition when the adrenal glands do not produce sufficient amounts of hormones, notably the vital cortisol. The other hormones produced by the adrenal gland that could be affected are aldosterone, dehydroepiandrosterone, and Adrenal androgens regulate various physiological functions, including maintaining blood pressure, balancing salt levels, and regulating metabolism.
Types of Adrenal Insufficiency
Adrenal insufficiency can be classified into two main types: primary and secondary.
- Primary Adrenal Insufficiency, also known as Addison’s Disease, occurs when there is direct damage to the adrenal glands, impairing their ability to produce hormones effectively. The most common cause of this damage is an autoimmune disease where the body’s immune system attacks the adrenal cortex.
- Secondary Adrenal Insufficiency happens when there is a deficiency of ACTH (adrenocorticotropic hormone) produced by the pituitary gland. ACTH is the hormone that stimulates the adrenal glands to produce cortisol; thus, its deficiency leads to decreased cortisol production.
Causes of Adrenal Insufficiency
- Autoimmune disorders are the leading cause of primary adrenal insufficiency. Infections, like tuberculosis or fungal infections, can also lead to this condition by damaging the adrenal glands.
- Cancer, bleeding, or genetic defects may also impair adrenal function.
- In secondary adrenal insufficiency, causes include pituitary tumours, long-term use of steroids, which can suppress ACTH production and damage to the pituitary gland from surgery or injury.
Symptoms of Adrenal Insufficiency
Chronic Fatigue
One of the most common symptoms, fatigue in adrenal insufficiency, is an overwhelming sense of exhaustion that doesn’t improve with sleep and can severely impact daily functioning. This occurs because cortisol plays a crucial role in regulating energy production and stamina.
Muscle Weakness
Patients often experience a decrease in muscle strength and endurance. This symptom is linked to both low cortisol levels, which affect muscle energy metabolism, and low aldosterone levels.
Weight Loss
Unexpected weight loss is common and may occur because of a combination of factors, including decreased appetite, increased metabolism from trying to compensate for low energy levels, and the body breaking down muscle for energy.
Low Blood Pressure
Cortisol and aldosterone both help maintain blood pressure. Cortisol influences the sensitivity of blood vessels to catecholamines (like adrenaline), whereas aldosterone regulates sodium and water balance. Their deficiency leads to a drop in blood pressure, which can cause symptoms like dizziness or fainting, especially upon standing (orthostatic hypotension).
If you have these symptoms, it is essential to seek help from an Endocrinologist as adrenal insufficiency can lead to life-threatening complications if it is not managed well.
Diagnosis of Adrenal Insufficiency
At Harmony Thyroid, Endocrinology and Diabetes Centre, Dr Vikram Sonawane, our experienced Endocrinologist in Singapore, will conduct a thorough assessment that may include:
- Blood Tests: They are conducted to measure levels of cortisol, ACTH, and aldosterone. Low cortisol and high ACTH levels can indicate primary adrenal insufficiency; low levels of both cortisol and ACTH suggest secondary adrenal insufficiency.
- ACTH Stimulation Test: It is a critical diagnostic tool where an injection of synthetic ACTH is administered, and cortisol levels are measured before and after. Poor increase in cortisol levels indicates adrenal insufficiency.
- Imaging Tests: CT scans or MRIs may be used to examine the adrenal and pituitary glands for abnormalities.
Treatment for Adrenal Insufficiency
Dr Vikram will tailor your treatment plan according to your condition, which typically includes hormone replacement therapy to correct the hormone deficiencies:
- Corticosteroids such as hydrocortisone, prednisone, or dexamethasone are prescribed to replace cortisol.
- Fludrocortisone acetate is used to replace aldosterone in cases of primary adrenal insufficiency.
- Extra glucocorticoids may be necessary during stressful times, such as serious illness or surgery.
The medication dosage would vary depending on a patient’s cortisol production levels.
If you or your loved ones are suffering from adrenal insufficiency, please schedule an appointment with our Senior Consultant Endocrinologist, Dr Vikram, from Harmony Thyroid, Endocrinology, and Diabetes Centre.
