adrenal insufficiency (gipokortitsizm) - a clinical syndrome that is caused by a decrease in the secretion of adrenal hormones.Gipokortitsizm may be primary, in which the violation of hormone associated with the destruction of the adrenal cortex, and secondary, in which there is a pathology of the hypothalamic-pituitary system.Primary adrenal insufficiency was first described by English physician Thomas Addison in the late 19th century in a patient with tuberculosis, so this form of the disease had another name, "Addison's disease".In this article we will talk about how to identify the symptoms of the disease and how to treat adrenal insufficiency. Content
Causes of primary hypocorticoidism enough, the main ones are as follows:
Symptoms usually appear when bilateral lesions when destructive proc
Secondary adrenal insufficiency occurs when the pathologies of the hypothalamic-pituitary system, when there is a lack of production of ACTH (adrenocorticotropic hormone), which is needed to produce the hormone cortisol by the adrenal cortex.Aldosterone production is almost independent of this factor, however, its concentration in the body is practically unchanged.It is with these facts connect that secondary form of the disease is milder than Addison's disease.
deficiency of adrenal hormones causes severe metabolic disorders, with a lack of aldosterone is a loss of sodium and potassium in the body of the delay, resulting in dehydration occurs.Disturbances of the electrolyte and water-salt metabolism have a negative effect on all body systems, mostly suffering from cardiovascular and digestive.The lack of cortisol translates into less adaptive capacity of the organism is disturbed carbohydrate metabolism, including glycogen synthesis.Therefore, the first signs of the disease often occur against the background of a variety of physiological stress (infectious diseases, injuries, exacerbation of other pathologies).
hyperpigmentation of the skin and mucous membranes.
hyperpigmentation (excessive staining) - the most pronounced symptom of the disease.This is due to the fact that cortisol hormone deficiency leading to increased ACTH production, which occurs when excess synthesis amplified melanocyte stimulating hormone, causes the symptom.
Intensity hyperpigmentation depends on the severity of the process.The first dark skin on the open areas of the body that are most susceptible to damage from ultraviolet (face, neck, hands), and visible mucous membranes (lips, cheeks, gums, palate).If Addison's disease is marked characteristic pigmentation of palms, dark places of friction skin clothing (eg, collar or belt).Skin may have a shade of smoky, reminiscent of the color of dirty skin to bronze.By the way, that's why this disease has another name - "bronze disease."
absence of this symptom, even if there are many other characteristic of the disease, is an occasion for a more detailed examination.However, it should be noted that there are cases where there is no hyperpigmentation, so-called "white addisonizm."
Patients report poor appetite, until its complete absence, epigastric pain, upset his chair, expressed in the form of alternating constipation and diarrhea.When the disease decompensation can join nausea and vomiting.As a result of the loss of sodium by the body appears distortion of eating habits, patients consume very salty food, sometimes even reaching the consumption of pure salt.
Weight loss can be very large to 15-25 kg, especially in the presence of obesity.This is due to a violation of the digestive processes, resulting in the body there is a lack of nutrients, as well as in violation of belkovosinteticheskih processes in the body.That is, the weight loss - this is the result of loss, primarily muscle, rather than fat mass.
Marked general weakness, fatigue, loss of ability to work.
patients a decline of emotion, they become irritable, sluggish, apathetic, half of the patients identified depressive disorders.
Lowering blood pressure is below normal, the occurrence of dizziness - a symptom which in most cases is accompanied by this disease.At the beginning of the disease may have only hypotension orthostatic character (there is a sharp rising from a lying down or with a long stay in an upright position) or triggered by stress.If gipokortitsizm developed with concurrent hypertension, the pressure may be normal.
Secondary gipokortitsizm clinical picture is different from the primary form of the disease lack of symptoms associated with a decrease in aldosterone production: hypotension, dyspepsia, taste for salty food.Also noteworthy lack of hyperpigmentation of the skin and mucous membranes.
At the forefront are such nonspecific symptoms as weakness and weight loss, as well as bouts of hypoglycemia (decrease in blood sugar), usually occur a few hours after a meal.During attacks, patients are hungry, complaining of weakness, dizziness, headache, chills, sweating.There blanching of the skin, rapid pulse, incoordination small movements.
People suffering gipokortitsizm necessary lifelong hormone replacement therapy.After confirmation of the diagnosis in most cases, treatment is initiated with parenteral (method of administering drugs, bypassing the gastrointestinal tract) administration of drugs hydrocortisone.When properly establish the diagnosis after several injections marked a pronounced positive effect, patients notice improvement of health, the gradual disappearance of the symptoms, a positive trend is observed in the test results.Lack of effect of treatment initiated gives reason to doubt the accuracy of diagnosis.
After stabilizing the patient's condition, as well as normalization of laboratory parameters, patients are assigned a constant maintenance therapy mineralocorticoid and glucocorticoid.Since the production of cortisol in the body has a certain circadian rhythm, the doctor prescribes a certain regimen of drugs, usually 2/3 of the dose should be taken in the morning, and the remaining 1/3 in the afternoon.
should be remembered that infectious diseases, SARS and even seasonal intestinal infections, injuries, operations, and situations of strong psycho-emotional stress are physiological stress for the body, so you need to increase the dose of drugs, sometimes 2-3 times, andin severe infections may require intravenous or intramuscular administration.Increasing the dosage of drugs should be coordinated with the doctor.
When properly chosen therapy quality and duration of life of patients suffering from adrenal insufficiency, substantially the same as that of healthy people.The presence of other associated autoimmune diseases (Addison's disease in 50-60% of patients with autoimmune thyroiditis cases detected), worsens the prognosis of patients.