Chronic Adrenal Insufficiency - Information Overview

A distinction is made between primary and secondary chronic adrenal insufficiency. The first is caused by damage to the adrenal cortex, the second occurs when the secretion of ACTH by the pituitary gland decreases or ceases.

In 1885, Addison described a disease of the adrenal glands caused by tuberculosis, 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, rare ones include tumors (angiomas, ganglioneuromas), metastases, infections (fungal, syphilis). The adrenal cortex is destroyed by thrombosis of veins and arteries. Complete removal of the adrenal glands is used to treat Itsenko-Cushing's disease, hypertension. Adrenal necrosis can occur in acquired immunodeficiency syndrome in homosexuals.

In recent decades, there has been an increase in autoimmune damage to the adrenal glands. In foreign literature, this disease is described under the name "autoimmune Addison's disease."

Causes and pathogenesis of chronic adrenal insufficiency

Patients complain of rapid fatigue, muscle weakness, weight loss, decreased or lost appetite, apathy, loss of interest in life. Hypotension and weight loss are noted.

Hyperpigmentation of the skin and mucous membranes is a distinctive sign of chronic primary adrenal insufficiency. Increased melanin deposition is observed on open and closed parts of the body, especially in places of clothing friction, on the palmar lines, in postoperative scars, on the mucous membranes of the oral cavity, in the area of the areola of the nipples, anus, external genitalia. Hyperpigmentation is a pathognomonic symptom of primary adrenal insufficiency and is never detected in secondary adrenal insufficiency. Only a small number of patients with primary adrenal damage may lack this symptom.

Symptoms of Chronic Adrenal Insufficiency

The diagnosis of chronic adrenal insufficiency is made on the basis of anamnestic data, the clinical picture of the disease, the results of a study of the function of the adrenal cortex, and also taking into account the state of other organs of the endocrine system.

The anamnesis of the disease is characterized by a long course, deterioration of health in the autumn-spring season, increased sensitivity to sunburn, decreased body weight, decreased appetite, rapid fatigue after physical exertion, dizziness, and 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 combinations of asthenia and adynamia with weight loss, hypotension, melasma, and mental disorders. The presence of hyperpigmentation always indicates primary adrenal insufficiency.

Diagnosis of chronic adrenal insufficiency

Treatment of chronic adrenal insufficiency is aimed, on the one hand, at eliminating the process that caused damage to the adrenal glands and, on the other hand, at replacing the lack of hormones.

If a tuberculous process in the adrenal glands is suspected, it is necessary to prescribe anti-tuberculosis drugs in courses under the supervision of a phthisiatrician. Patients with autoimmune damage to the adrenal glands are treated with levomisol and thymosin, aimed at normalizing the deficiency of T-suppressors. At present, it has not received widespread use.

The recommended diet for hypocorticism should contain an increased amount of calories, proteins, vitamins, and table salt up to 3-10 g/day.

Treatment of chronic adrenal insufficiency

[ 1 ], [ 2 ]