Background:Each adrenal gland is located near the upper pole of a kidney. They synthesize and secrete into the bloodstream more than 20 different hormones, all necessary for maintaining normal life and most based on the same molecular structure (steroids). Each steroid hormone is available in synthetic form identical to the natural hormone. Inborn enzyme mutations in the sequential synthesis of adrenal hormones are rare. They may cause easily recognizable abnormal body developments and in some cases be incompatible with life. Best known among the hormones is cortisol that has effects on metabolism, immune reactions, and brain function among several life sustaining actions. Other adrenal hormones regulate blood pressure and salt and water balance in the kidneys. The adrenal glands produce male and female sex hormones identical to the steroid hormones produced in testes and ovaries. Many hormone secretions by the adrenals are regulated by feedback interplay with the pituitary hormones ACTH and LH that reach the adrenals through the blood stream. Most of these feedback circuits function in individual diurnal patterns governed by secretion of hormones from the hypothalamus throughout the 24 hours.
Reduced Adrenal Function:
Reduced overall function of both adrenals is rare, but when it occurs the most serious effect is reduction of cortisol production and constitutes a severe life-threatening condition. The normal function of just one adrenal gland is sufficient for sustaining normal life.
Symptoms: Abnormally low cortisol production will cause weight loss, low blood sugar, muscle weakness, compromised immune defense, lower back pain, low blood pressure, and fatigue. This combination of symptoms is easily distinguishable from the chronic fatigue syndrome. The popular concept of “tired adrenals” is not recognized by professional endocrinologists. Reduced general adrenal function is most often caused by an autoimmune process and may be part of general autoimmune syndromes.
Diagnosis: Reduced adrenal function may be diagnosed by measurement of cortisol in blood, in 24 hr. urine, or in saliva. Reduced function may rarely be secondary to pituitary insufficiency.
Treatment: Reduced adrenal function may be treated by cortisol and by a hormone regulating the salt balance. Both hormones may be administered as tablets. High cortisol doses are used in the treatment of many non-adrenal diseases. Treatment with pharmaceutical doses of cortisol for more than four weeks will suppress ACTH through the feedback effect on the pituitary and thereby reduce the adrenals’ own production of cortisol. Following such pharmaceutical suppression, the pituitary and adrenal glands must be slowly weaned into effect again by tapering the cortisol dose over five to six weeks to avoid potentially fatal adrenal insufficiency.
Increased Adrenal Function:
Increased function is most commonly caused by autonomous adrenal tissue or by the presence of an autonomous adrenal tumor in one of the adrenal glands. It may also be secondary to high production of ACTH.
Symptoms: Increased production of cortisol may cause increased body weight with a characteristic distribution of body fat, high blood pressure, elevated blood sugar, osteoporosis. A special tumor in the adrenals producing the steroid hormone aldosterone is the cause of five to ten percent of cases of elevated blood pressure in the general population. Metastases from various cancer forms may be located to the adrenals.
Diagnosis: Increased adrenal hormone production is diagnosed by clinical symptoms and measurements of hormones in blood, 24 hr urine or saliva. Adrenal tumors are recognized by CT or MRI scans.
Treatment:Increased adrenal function may be treated by oral medication, but permanent treatment requires surgical intervention often by the removal of an autonomous solitary tumor.
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