Adrenal insufficiency is a syndrome caused by a primary violation of the adrenal cortex (Addison’s disease) or its secondary changes due to a decrease in ACTH secretion; manifested by symptoms of reduced production of adrenal hormones. There are chronic and acute adrenal insufficiency.
Primary adrenal insufficiency is caused by tuberculosis (in 40% of cases) or atrophy of the adrenal cortex caused by autoimmune processes (in 50% of cases).
More rare causes are bilateral adrenalectomy, thrombosis, or embolism of the adrenal vessels. In patients with immunodeficiency, for example, with AIDS, a fungal infection of the adrenal cortex is likely. A common underlying cause of acute adrenal insufficiency is meningococcal infection.
The cause of secondary insufficiency may be postpartum necrosis of the pituitary gland (Sheehan’s syndrome), pituitary tumors, hypophysectomy, craniopharyngioma. Another common underlying cause of secondary adrenal insufficiency is long-term treatment with glucocorticoids, for example, for autoimmune diseases.
A decrease in cortisol secretion leads to a violation of protein and carbohydrate metabolism, and aldosterone deficiency leads to a violation of mineral metabolism.
The main clinical symptoms of primary hypocorticism (Addison’s disease) are: hyperpigmentation of the skin and mucous membranes, weight loss, general weakness, asthenia, depression, decreased libido, arterial hypotension, dyspeptic disorders, addiction to salty foods.
The diagnosis is made on the basis of a decrease in the initial level of 17-OCS in urine and plasma, as well as a preserved response to ACTH.
Treatment of primary and secondary adrenal insufficiency is the introduction of hormones of the adrenal cortex. Apply prednisolone (prednisone) 5-10 mg or cortisone 25-50 mg every day; combinations of prednisolone and cortisone are recommended; 2 / d doses of hormones are taken orally in the morning and 1/3 – in the afternoon (required after meals). If blood pressure has not returned to normal, then add deoxycorticosterone acetate 5 mg in an oil solution IM every day, every other day or 2 times a week or in tablets of 5 mg 1-3 times every day under the tongue.