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| | | |  Home  Disease Index Adrenal Glands (Hypoadrenalism)
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 | What is hypoadrenalism? |
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The are two small but very important glands, situated one above each kidney, which produce a range of hormones, or 'chemical messengers'. Underactivity of the is called hypoadrenalism.
Many of the symptoms of hypoadrenalism are due to a deficiency of the steroid hormone cortisol, which is a potentially fatal deficiency if left uncorrected. Each adrenal gland consists of two parts:
 an outer ring - the cortex
an inner core - the medulla.
The two parts have separate hormone functions and control mechanisms. The production of cortisol in the cortex is controlled by the hormone adrenocorticotropin (ACTH), which is produced by the at the base of the brain.
The way in which the pituitary gland regulates the normal production of steroid hormones by the is through the secretion of ACTH. If the adrenal gland produces too little cortisol, then there will be a lower level of cortisol in the blood. This is sensed by the pituitary, which therefore will increase the release of ACTH, which in turn stimulates the adrenal cortex to produce more cortisol.
Conversely, too much circulating steroid hormone will switch off the release of ACTH from the pituitary gland, which in turn reduces the production of steroids.
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| What causes hypoadrenalism? |
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Primary hypoadrenalism or
Primary hypoadrenalism, or Addison's disease, results from failure of the themselves. This is usually an 'autoimmune' disease, where the immune system produces antibodies that attack tissues of the body rather than a virus or bacteria. In Addison's disease, antibodies attack the adrenal cortex, causing damage and scarring. Antibodies to the adrenal cortex can be detected in the blood of some patients.
Secondary or ACTH deficiency
Secondary hypoadrenalism, or ACTH deficiency hypoadrenalism, is caused by diseases of the pituitary gland, which lead to Other causes
Tuberculosis of the may also cause hypoadrenalism. This was a common cause of Addison's disease in Britain before the 20th century and remains a major cause in underdeveloped countries. Tuberculosis destroys the whole gland, both the cortex and the medulla. There are usually signs of tuberculosis in other organs, particularly the lungs. Destruction of the adrenal glands by tuberculosis is irreversible once hormonal deficiencies are clinically detectable. Rare causes
Many rare diseases may affect the In general, at least 80 per cent of both adrenal glands have to be damaged in order for deficiencies to become clinically evident. Rare conditions associated with primary and secondary hypoadrenalism include:
Rare conditions associated with primary hypoadrenalism
(a genetic disease in which the myelin sheath, or 'insulation', covering the nerve fibres within the brain is lost, along with degeneration of the ).
Amyloidosis (a rare condition in which an abnormal substance called amyloid is laid down in various tissues, impairing their function).
Bilateral adrenalectomy (surgical removal of the adrenal glands).
Congenital (a common inherited condition in which an enzyme defect causes problems with the production of steroid hormones by the ).
Drugs (eg ketoconazole, metyrapone, mitotane).
Familial glucocorticoid deficiency (ACTH receptor mutation).
Haemochromatosis.
Haemorrhage - usually in patients receiving anticoagulant drugs or in whom septicaemia ('blood poisoning') is present.
HIV-related adrenal inflammation.
Metastases (spread of cancer from another part of the body.
Sarcoidosis. Rare conditions associated with
This means adrenal deficiency from causes acting on the pituitary gland rather than directly on the adrenal glands. The pituitary gland regulates production by responding to the amount of cortisol in the blood. However, the pituitary cannot distinguish between and synthetic steroid absorbed from medicines or steroid creams.
If someone takes such treatment the pituitary production of will drop and as a result the adrenal cortex will become relatively inactive. If the steroid treatment is stopped abruptly then the patient may suddenly become deficient in cortisol as the takes some time - weeks or months - to regain its full manufacturing ability again. This is the reason that patients on medium or long-term steroid treatment are advised not to stop taking their medicine suddenly.
Rarely, patients are affected by conditions that destroy the pituitary. Any cause of pituitary disease may cause
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| What are the symptoms of hypoadrenalism? |
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The onset of symptoms in is usually subtle. Patients often feel faint and dizzy, and often experience weakness, fatigue and weight loss. At least 50 per cent of patients complain of vague stomachaches or other gut symptoms.
Increased pigmentation of the skin (like a sun tan) is common in . Some patients will have a persistent tan long after a holiday. This is due to raised ACTH levels, which stimulate pigment cells (melanocytes) in the skin.
Patients occasionally suffer mental problems, including depression. Some suffer joint and muscle pain. Very rarely, bleeding into the (see Figure 1 in appendix) causes acute severe back pain. This symptom should be particularly investigated in patients receiving anticoagulants, such as warfarin, which prevent blood clots. In some severe infections, particularly meningococcal septicaemia, bleeding may occur into the adrenal glands. The loss of cortisol results in hypotension (low blood pressure) that fails to respond to catecholamine hormones and medications (eg noradrenaline).
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