Adrenal gland is a small sized gland located on the upper pole of each kidney. This gland produces hormone which has varied functions in human body. Adrenal gland secretes cortisol, aldosterone and androgen hormones. Adrenal hypofunction is a state in which the secretion of these hormones in reduced considerably to produce symptoms such as weakness of muscles, chronic fatigue, loss of appetite, pain in abdomen etc.Adrenal hypofunction is also known as adrenal insufficiency.
Hypofunction of adrenal glands can be primary where the gland is directly affected. Secondary adrenal hypofunction occurs when problem lies in pituitary gland. It is a pea sized gland in brain. Pituitary gland releases hormone ACTH which when released stimulates the adrenal to produce cortisol and aldosterone. If the output of ACTH is diminished, naturally the level of cortisol in blood will reduce.
There are several factors that may lead to adrenal hypofucntion, a tumor in pituitary gland or adrenal gland, an autoimmune disease or an infection such as tuberculosis can reduce production of adrenal hormones. Adrenal hypofunction once diagnosed can be treated by supplementation of synthetic hormones.
What Causes Adrenal Hypofunction?
There are number of causes attributing to hypofunction of adrenal gland. Hypofunction can be primary or secondary. Primary adrenal insufficiency occurs when the fault is in adrenal gland itself, it leads to a condition called addison’s disease. Secondary hypofunction occurs when the pituitary gland is damaged. Secondary adrenal hypofunction is more common than addison’s disease.
There are three main reasons that may cause primary adrenal hypofunction:
- Autoimmune disorder: It is a condition in which body’s own immune system destroys tissues and cells. Primary adrenal hypofunction or Addison’s disease is an autoimmune disease. In this disease the immune system destroys the outer layer of adrenal gland. It is mainly prevalent in middle aged women.
- Infection: The commonest cause in underdeveloped countries of Addison’s disease is tuberculosis. It destroys the adrenal gland. Other infection that can cause this disorder are viral infection especially HIV, histoplasmosis, cryptococcosis, etc.
- Other causes include tumor of adrenal gland, surgical removal of the gland, destruction of gland due to radiation, hemorrhage in the gland, and certain anti fungal medicines.
Cause of secondary adrenal hypofunction:
Disorder of pituitary gland can cause secondary adrenal hypofunction.
- Sudden stoppage of corticosteroid medicine after a long term use may cause secondary adrenal hypofunction.
- Surgical removal of non cancerous tumor of pituitary gland.
- Infection in pituitary gland.
- Reduced blood flow to pituitary gland.
Signs And Symptoms Of Adrenal Hypofunction
Before we know the symptoms, let us understand the functions of adrenal hormones. The function of cortisol is to maintain blood pressure and functioning of the blood vessels, regulate metabolic activity and slow down the inflammatory response of the immune system. Aldosterone helps in balancing sodium and potassium in body.
It is also involved in maintaining blood pressure. Hormone DHEA is produced by adrenal gland. It is concerted into testosterone and estrogen hormones. They are sex hormones in male and female. The symptoms of adrenal hypofunction are as follows:
- Chronic fatigue
- Low blood pressure
- Low blood sugar
- Craving for salt
- Excessive sweating
- Weight loss
- Lack of desire to eat.
- Nausea and vomiting.
- Vague abdominal discomfort.
- Dark brown pigmentation of skin in exposed areas and on pressure site. The common sites are knuckles, ankles, elbow, knee, nail bed.
- Increased thirst for cold water and fluids.
- In females loss of underarm and pubic hair.
- Women lose interest in sex.
How To Treat Adrenal Hypofunction?
All patients with adrenal hypofunction need to take lifelong hormone replacement therapy. Both glucocorticoids and mineralcorticoid hormones are included in the therapy. Patients are advised to take cortisone either with milk or meals because it can irritate gastric lining. The dose and interval are prescribed by the physician after taking into consideration of patient’s age, weight, etc.
Along with hormone therapy, diet plays important role in management of adrenal hypofunction. Some patients who are deficient in aldosterone hormone may benefit by adding little more salt in their diet. However, be careful if you are hypertensive patient.
Patient should also eat dairy foods as they contain rich amount of calcium. This is because long term use of corticosteroids can cause osteoporosis. To replenish lost calcium, he has to include calcium containing food in his diet.