Symptoms 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. 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 5-10 times, and the biosynthesis of hormones of the intact part of the adrenal glands increases. As a result, adequate amounts of hormones are secreted for an indefinite period of time. Rapid increase in 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 Addisonian crisis - acute adrenal insufficiency. On the contrary, a decrease in pigmentation is observed during compensation of adrenal insufficiency, achieved by prescribing adequate doses of synthetic analogues of hormones, lightening of the skin and mucous membranes is accompanied by a decrease in ACTH in the plasma. In rare cases, ACTH-producing pituitary adenomas may occur in Addison's disease. It is assumed that long-term stimulation of the adenohypophysis due to low cortisol production leads to the formation of secondary adenomas.

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

Hypotension is one of the early and obligatory manifestations of chronic adrenal insufficiency. Systolic pressure is 110-90 mm Hg, diastolic - 70 and below. In rare cases, arterial pressure may remain normal or elevated (in patients suffering from hypertension in addition to adrenal insufficiency). This combination is most often encountered after bilateral adrenalectomy for Itsenko-Cushing's disease.

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

Weight loss in Addison's disease is associated with a true decrease in muscle mass and loss of tissue fluid.

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

Chronic adrenal insufficiency reduces the function of the sex glands. A decrease in the secretion of gonadotropins, especially FSH, has been detected. Deficiency of adrenal hormones disrupts reproductive function and causes pregnancy pathology.

Mental disorders occur in more than half of patients with Addison's disease. In chronic adrenal insufficiency, mental and neurological disorders are detected. Sometimes they are unstable and mild. Apathy or irritability, memory impairment are noted. As the disease progresses, initiative decreases, thinking becomes poor, and negativism occurs. Acute mental states accompanied by hallucinations are observed quite rarely. In patients with adrenal cortex hormone secretion deficiency, the EEG shows changes: slow waves in all leads, a decrease in the number of alpha and beta waves.

Most researchers associate a decrease in mental activity and changes in the electroencephalogram with a metabolic disorder in brain tissue caused by a decrease in blood glucose levels and chronic hypoglycemia. Increased secretion of ACTH in patients with primary adrenal damage also affects behavioral reactions and memory processes.

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