Adrenal Gland Hormonal Disorders
A hormone is a chemical signal made by one organ that travels (usually through the blood) to other tissues, causing an effect in those tissues. Hormones are produced by a system of organs or glands (known collectively as the endocrine system) that are scattered throughout the body. Each gland makes specific hormones, which are released when needed to help the body maintain a healthy balance.
One adrenal gland is located on top of each kidney. Adrenal glands produce the following hormones:
- Epinephrine, targets circulatory system and liver; increases heart rate and blood pressure and raises blood glucose.
- Norepinephrine, targets heart, lungs and blood vessels; increases blood presserue.
- Dehydroepiandrosterone (DHEA), targets most tissues; may have a role in aiding the immune system (main functions are unknown).
- Aldosterone, targets kidneys; regulates exchange of sodium and potassium and regulates blood pressure.
- Cortisol, targets most tissues; calms inflammation; helps maintain blood pressure; and affects the metabolism of carbohydrates, protein, and fats.
ADRENAL GLAND DISORDERS
Addison Disease is a rare hormonal disorder when the adrenal glands do not make enough of the hormones cortisol and aldosterone. Most cases of Addison disease are caused by an autoimmune disease in which the immune system produces antibodies that attack and destroy the outer layer (cortex) of the adrenal glands, reducing hormone production.
Some cases are caused by cancers that spread (metastize) to the adrenal glands from other parts of the body, such as the lungs and breasts. Other cases are caused by infections, such as tuberculosis.
Symptoms of the Addison disease develop gradually. You may feel tired and weak and may lose your appetite. Weight loss, nausea, diarrhea, and vomiting are common, dizziness or fainting caused by reduced blood pressure may also occur. You skin may darken because of increased production by the pituitary gland of the hormone that stimulates the production of skin pigment (melanin). You may also become irritable and depressed, have irregular menstrual periods and have symptoms of low blood sugar.
A stressful event such as an injury or infection can trigger and addisonian crisis, which is characterized by nausea, vomiting, abdominal pain, dehydration, low blood pressure, disorientation, and loss of conciousness.
The crisis occurs because the adrenal glands, which normally increase their production of hormones during times of stress, cannot produce the hormones. An addisonian crisis can be life threatening.
Treatment If you suspect that you have Addison disease, see your doctor who will arrange for an adrenocorticotropic hormone (ACTH) stimulation test. ACTH is produced by the pituitary gland and triggers the adrenal glands to release their hormones. If your adrenal glands do not respond to the ACTH injection by making adrenal hormones, the diagnosis is confirmed.
Treatment involves taking replacement hormones in the form of corticosteroid drugs. There are two critically important corticosteroids that are deficient in a person with Addison disease (and that need to be replaced): cortisol and aldosterone. The medicine most often used to replace the missing cortisol is prednisone; fludrocortisone is used to replace the missing aldosterone. Your doctor may also recommend increasing your salt intake.
Whenever you are faced with major stress, such as surgery, you will be given addtional, intravenous injections of hydrocortisone, a salty fluid, and glucose.
All people with Addison disease should wear a medical identification bracelet so that, if they are found unconcious, doctors will know to give them potentially lifesaving corticosteroid treatment.
Western diets provide from several milligrams to a gram of flavonoids each day. Mixed diets contain flavonoids from all five subclasses. Most of the food flavonoids have glucose or some other sugar attached. These sugar-coated flavonoids are called falvonoid glycosides.
Aldosteronism, also known as hyperaldosteronism, is a condition caused by excess production of aldosterone, a hormone made by the adrenal gland. The surplus causes the body to retain salt, which can cause fluid retention and high blood pressure, and too little potassium.
In rare cases, aldosteronism is caused by a tumor or general enlargement of the adrenal gland; this is called primary aldosteronism or Conn syndrome.
More often, aldosteronism is caused by a condition that reduces the flow of the bloof through the kidneys, such as cirrhosis or heart failure. This is called secondary aldosteronism.
Symptoms include high blood pressure (which is caused by a high level of sodium) as well as fatigue and muscle weakness (which is caused by a low level of potassium).
Treatment Report your symptoms to your doctor who will perform tests to measure levels of sodium and potassium in your blood and urine. If primary aldosteronism is suspected, you will have repeated blood tests of sodium and potassium, aldosterone, and renin (another chemical made by the kidneys), often after altering your diet or taking a pill that can bring out the abnormality.
Your doctor may also arrange for you to have computed tomography to determine if a tumor of the adrenal glands is causing the condition; if there is a tumor, it will be removed.
Treatment for secondary aldosteronism involves restricting your salt intake and increasing foods that are rich in potassium. Your will also take the diuretic medicine spironolactone, which interferes with the effect of aldosterone on your kidneys, leading to increased excretion of sodium, decreased excretion of potassium, and, consequently, lower blood pressure.
Cushing Syndrome and Cushing Disease Cushing syndrome is a rare condition in which there is too much cortisol, the stress hormone, in your blood. Many people develop Cushing syndrome as a result of taking cortisol-like corticosteroid drugs for long periods. In healthy people, the adrenal glands produce cortisol in appropriate amounts.
Occasionally, Cushing syndrome is caused by a tumor somewhere in the body that makes adrenocorticotropic hormone (ACTH), a hormone that travels to the adrenal glands and stimulates them to produce cortisol.
When the tumor producing ACTH is in the pituitary gland, the disorder is called Cushing disease.
Symptoms include a change in body shape and facial features. The upper body accumulates fat (sometimes between the shoulder blades) but the arms and legs become thin because of muscle wasting. The face also accumulates fat and becomes round and red. Skin may be thin and easily bruised, and purple stretch marks may develop on the abdomen, breasts, and thighs.
Women often have excess hair (hirsutism) and men have have reduced sexual desire. The bones become thin from osteoporosis and are subject to fracture. Fatigue, weak muscles, high blood pressure, and high blood sugar are common. You may also feel irritable, depressed, and anxious.
Treatment depends on the underlying cause. If your condition is caused by long-term use of corticosteroid drugs, your doctor will slowly reduce your dosage. Never change your dosage pf corticosteroids without consulting your doctor first; if you reduce the dosage below what the body needs, it can cause the addisonian crisis, which can be life-threatening.
Other causes are based on your symptoms and on laboratory tests. Your primary care doctor or a consulting endocrinologist may start with dexamethasone supression test. Normally, the hypothalamus in the brain makes a hormone called corticotropin-releasing hormone (CRH), which causes the pituitary gland in the brain to release adrenocorticotropic hormone (ACTH). ACTH causes the adrenal glands to make cortisol. This cascade is controlled by negative feedback.
For the test, you take a cortisol-like medicine called dexamethasone at night. If you do not have Cushing syndrome, the dexamethasone will, throught negative feedback, cause the hypothalamus to produce less ACTH, and the adrenal glands to produce less cortisol. Therefore, the next morning, cortisol levels in your blood will be low.
If you have Cushing syndrome caused by a tumor (in the pituitary gland or in another organ such as a lung) that is making ACHT, the tumor will continue to make ACHT. In the morning, your blood levels of ACHT and cortisol will be high because the tumors do not respond to the negative feedback of the dexamethasone; they continue to make ACHT.
If you have a tumor in an adrenal gland that is causing the gland to make too much cortisol, the level of cortisol in the blood will be high but the level of ACHT will be low. This is because the hypothalamus and pituitary gland are responding normally to negative feedback.
If it is established that you have Cushing syndrome that may be due to a tomor, your doctor may take pictures of your pituitary gland, chest, adrenal glands using x-rays, magnetic resonance imaging, and computed tomography.
If you have a pituitary gland tumor, it will be removed; sometimes radiation therapy is given afterward. If you have a tumor of adrenal , your doctor will also recommend surgery, to remove it. If both adrenal glands must be removed, you will need corticosteroid drugs to replace the hormones that your body can no longer produce.
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