Symptoms 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. Darkening of the skin is almost always one of the first manifestations of the disease, since a decrease in the secretion of hormones by the adrenal cortex leads to an increase in the secretion of ACTH. It increases by 5-10 times, and biosynthesis of hormones of the undestroyed part of the adrenal gland increases. Because of this indefinite time, adequate amounts of hormones are secreted. Rapid enhancement of pigmentation of the skin and mucous membranes indicates an increase in the severity of the disease and is a prognostic symptom of the onset of an addisonic crisis - acute adrenal insufficiency. On the contrary, a decrease in pigmentation is observed with compensation of adrenal insufficiency, achieved by the appointment of adequate doses of synthetic hormone analogues, lightening of the skin and mucous membranes is accompanied by a decrease in ACTH in the plasma. In rare cases with Addison's disease, the occurrence of ACTH-producing adenomas of the pituitary gland is possible. It is believed that the long-term stimulation of the adenohypophysis due to low production of cortisol leads to the formation of secondary adenomas.

5-20% of patients with primary chronic insufficiency appear on the skin depigmented areas of vitiligo.

Hypotension is one of the earliest and mandatory manifestations of chronic adrenal insufficiency. The systolic pressure is 110-90 mm Hg. Diastolic - 70 and below. In rare cases, blood pressure may remain normal or elevated (in patients suffering from hypertension other than adrenal insufficiency). Most often, this combination occurs after bilateral adrenalectomy about the Itenko-Cushing disease.

Characteristic for addison's disease are dizziness, fainting, tachycardia, progressive weakness, hypoglycemic conditions. Glucocorticoids and aldosterone play a role in maintaining the normal level of blood pressure, gluconeogenesis processes, and the androgens secreted by the adrenal cortex have an anabolic effect. If their secretion is insufficient, the tone of the arterioles and capillaries decreases, the plasma sugar level and the anabolic processes in the tissues and muscles decrease. In this regard, the body weight decreases and marked asthenia occurs. Loss of body weight - almost a constant symptom of Addison's disease - can be gradual or rapid. Weight loss usually correlates with the degree of impaired appetite and the severity of gastrointestinal disorders. The latter are of great variety: a decrease and loss of appetite, abdominal pain, usually without a clear localization, intensifying during the period of decompensation of the disease. Typical and frequent manifestations are hypoacid gastritis, spastic colitis, often ulcerative lesions of the stomach and duodenum. The predominance of complaints of changes in the gastrointestinal tract in some patients leads to late diagnosis of chronic adrenal insufficiency; patients for a long time are observed in gastroenterologists.

Decreased body weight in Addison's disease is associated with a true decrease in the amount of muscle tissue and loss of fluid tissues.

Asthenia occurs in most patients with chronic adrenal insufficiency and is characterized by general weakness, lethargy, the inability to lead an active lifestyle. Rest, as a rule, does not lead to the restoration of strength and vivacity. Often, patients are difficult to get out of bed because of dizziness and darkness in the eyes, nausea. Asthenia is associated with a violation of all types of metabolism - electrolyte, carbohydrate, protein; decrease and disappearance of it occurs after compensation of adrenal insufficiency.

With chronic adrenal insufficiency, the function of the sex glands decreases. Reduced secretion of gonadotropins, especially FSH. Lack of adrenal hormones disrupts reproductive function, causes pathology of pregnancy.

Mental disorders occur in more than half of patients with Addison's disease. With chronic adrenal insufficiency, mental and neurological disorders are revealed. Sometimes they are unstable and light. Apathy or irritability, memory impairment are noted. With the development of the disease there are declining initiatives, impoverishment of thinking, negativism. Acute mental states, accompanied by hallucinations, are observed quite rarely. In patients with insufficient secretion of hormones in the adrenal cortex on the EEG, changes are observed: slowed waves in all leads, a decrease in the number of alpha and beta waves.

The decrease in mental activity and the change in the electroencephalogram is attributed to the majority of researchers with a metabolic disorder in the brain tissue caused by a decrease in blood glucose and chronic hypoglycemia. Increased secretion of ACTH in patients with primary adrenal damage also affects behavioral reactions, memory processes.

[1], [2], [3], [4], [5], [6]