Chronic adrenal insufficiency: a review of information
Last reviewed: 23.04.2024
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There are primary and secondary chronic adrenal insufficiency. The first is caused by the defeat of the cortical layer of the adrenal glands, the second occurs when the secretion of ACTH by the pituitary gland decreases or ceases.
In 1885, Dpdison described the adrenal disease caused by their tuberculous lesion, so the term "Addison's disease" became synonymous with primary chronic adrenal insufficiency.
Causes of chronic adrenal insufficiency. The most common causes of primary destruction of the adrenal glands include autoimmune processes and tuberculosis, to rare - tumors (angiomas, ganglioneuromas), metastases, infections (fungal, syphilis). The adrenal cortex breaks down with thrombosis of veins and arteries. Complete removal of the adrenal glands is used to treat the Itenko-Cushing disease, hypertensive disease. Necrosis of the adrenal gland can occur in the syndrome of acquired immunodeficiency in homosexuals.
Over the past decade, there has been an increase in autoimmune involvement of the adrenal glands. In foreign literature, this disease is described as "autoimmune Addison's disease."
Causes and pathogenesis of chronic adrenal insufficiency
Patients complain of rapid fatigue, muscle weakness, weight loss, loss or loss of appetite, apathy, loss of interest in life. There is hypotension, weight loss.
Hyperpigmentation of the skin and mucous membranes is a hallmark of chronic primary adrenal insufficiency. Increased deposition of melanin is observed on open and closed parts of the body, especially in places of clothing rubbing, on palmar lines, in postoperative cicatrixes, on the mucous membranes of the oral cavity, in the area of areola nipples, anal opening, external genitalia. Hyperpigmentation is a pathognomonic symptom of primary adrenal insufficiency and is never detected with secondary adrenal insufficiency. Only in a small number of patients with primary adrenal gland this symptom may be absent.
Symptoms of chronic adrenal insufficiency
Diagnosis of chronic adrenal insufficiency is based on anamnestic data, clinical picture of the disease, the results of the study of the function of the adrenal cortex, as well as taking into account the state of other organs of the endocrine system.
Anamnesis of the disease is characterized by the duration of the course, deterioration of well-being in the autumn-spring season, increased sensitivity to sunburn, decreased body weight, decreased appetite, rapid fatigue after physical exertion, dizziness, fainting.
Based on the analysis of the frequency of clinical symptoms of Addison's disease, it has been shown that the most informative signs are the combination of asthenia and adynamia with a decrease in body weight, hypotension, melanoderma, and mental abnormalities. The presence of hyperpigmentation always indicates a primary adrenal insufficiency.
Diagnosis of chronic adrenal insufficiency
Treatment of chronic adrenal insufficiency is aimed, on the one hand, to eliminate the process that caused adrenal damage and, on the other hand, to replace the lack of hormones.
If a tuberculosis process in the adrenal gland is suspected, it is necessary to prescribe anti-tuberculosis drugs under the supervision of a phthisiatrician. Patients with an autoimmune lesion of the adrenal glands are treated with levomizol and thymosin, aimed at normalizing the deficit of T suppressors. At present, it is not widely used.
The recommended diet for hypocorticism should contain an increased number of calories, proteins, vitamins, table salt to 3-10 g / day.
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