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Adrenal Insufficiency is a rare endocrine or hormonal disorder in which the adrenal glands don't produce enough hormones. It usually affects about 2-3 individuals in millions. Adrenal Insufficiency affects all age groups and gender. If the adrenal glands are not functioning properly, the entire body can be affected severely.
- Adrenal Insufficiency occurs when the Adrenal Glands produce less than the optimum amount of Aldosterone and cortisol.
- A prolonged lack of cortisol results in severe fatigue, chronic exhaustion, loss of appetite, and weight loss.
- Deprivation of steroid hormones leads to a drop in blood pressure, fatigue, reduced sex drive, and loss of hair in the pubic and underarm areas.
Key Terms: Adrenal Insufficiency, Adrenal Cortex, Adrenal Medulla, Glucocorticoids, Mineralocorticoids, Adrenal Glands, Hormones, Stress
What are Adrenal Glands?
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Adrenal Glands are a pair of glands located on the anterior part of each kidney. It comprises two components:
- Adrenal Cortex: It produces Cortisol and Aldosterone hormones. Adrenal Cortex is the outer part of the gland. When the cortex does not produce the hormones to the optimum level, it is called Adrenal Insufficiency.
- Adrenal Medulla: It is centrally located. It produces adrenaline or epinephrine and noradrenaline or norepinephrine. These are also called catecholamines emergency hormones or Flight or Fight hormones. They are rapidly secreted in response to stress.
Adrenal Gland
What is Adrenal Insufficiency?
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Adrenal Insufficiency is a disorder in which the adrenal glands do not generate enough steroid hormones. Glucocorticoids, predominantly cortisol, mineralocorticoids, especially aldosterone, and androgens are routinely secreted by the adrenal gland.
- These hormones have a vital role in the control of electrolytes, metabolism, and blood pressure.
- When these hormones are deficient, people have symptoms ranging from nausea and vomiting to low blood pressure, depression, mood swings, and personality changes (in moderate instances) to organ failure and shock (in severe cases).
- An adrenal crisis, a potentially fatal medical illness brought on by a severe lack of cortisol in the body, can happen if the body is under stress from an accident, injury, surgery, or severe infection.
- A lack of enzymes, Addison's disease, inability to develop (adrenal dysgenesis), or malfunction of the adrenal gland itself can all result in adrenal insufficiency.
- When the pituitary gland or the brain does not generate enough of the hormones that help regulate adrenal function, adrenal insufficiency can also happen.
- When the pituitary gland is not producing enough adrenocorticotropic hormone (ACTH), it is referred to as secondary adrenal insufficiency, and when the hypothalamus is not producing enough corticotropin-releasing hormone (CRH), it is referred to as tertiary adrenal insufficiency.
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Types of Adrenal Insufficiency
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Adrenal Insufficiency is of three types:
Primary Adrenal Insufficiency
It is a rare endocrine disorder in which the body is unable to produce the requisite amount of hormones, particularly aldosterone and cortisol. It is also called Addison’s disease. It is called primary as the problem lies within the Adrenal gland itself.
Causes of Primary Adrenal Insufficiency
- Autoimmune Adrenalitis: In this case, the body's own B cells and the D cells attack the adrenal glands and damage them.
- Infections: Infections caused by organisms like mycobacterium tuberculosis, and fungal infections like Histoplasmosis, might also trigger Adrenal Insufficiency.
- Adrenal Infection: Systemic lupus erythematosus and antiphospholipid antibody syndrome may cause Adrenal Infection which might lead to Adrenal Insufficiency.
- Drugs: Certain drugs like mitotic and ketoconazole, when taken in excess quantity might damage the adrenal glands and cause Adrenal Insufficiency.
- Metastasis: Metastasis from the organs like the lungs and the stomach can also damage the adrenal glands and cause Adrenal Insufficiency.
- Trauma: Blunt or Sharp Trauma to the abdomen will also cause damage to the adrenal gland. This can also result in Adrenal Insufficiency.
- Adrenal Hemorrhage: This usually occurs in the case of Waterhouse Fredrickson syndrome and anticoagulation therapy can also cause adrenal insufficiency. This can also result in Adrenal Insufficiency.
- Storage Disorders: Storage disorders like amyloidosis and hemochromatosis affect the adrenal gland and cause Adrenal Insufficiency.
- Surgery: The surgical removal of the adrenal gland which is also known as the bilateral adrenalectomy causes Addison's disease, and might also cause Adrenal Insufficiency.
Adrenal Insufficiency
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Secondary Adrenal Insufficiency
The disorder is caused due to the absence of normal stimulation to the adrenal cortex from lack of ACTH. Here, the pathology does not lie in the adrenal gland but rather the insufficiency occurs due to other factors.
Causes of Secondary Adrenal Insufficiency
- Any harm or injury to the hypothalamus of the pituitary like Pituitary inflated, Inflated tumours, Granulomatosis disease, Radiation, etc can cause Adrenal Insufficiency.
- Medicines can bind to the hypothalamic and pituitary glucocorticoid receptors and suppress the entire hypothalamic pituitary adrenal access. Excess opioid usage can also contribute to Adrenal Insufficiency.
- A condition that damages your pituitary gland will eventually result in reduced production of ACTH, which then further leads to the cortex not receiving sufficient hormones to stimulate it.
- Patients with asthma or arthritis if they miss corticosteroid dosage will also lead to Cortex malfunction and which is also known as Secondary Adrenal Insufficiency.
Tertiary Adrenal Insufficiency
It occurs when the hypothalamus fails to produce enough corticotropin-releasing hormone. Because of this, the pituitary gland fails to produce adequate ACTH. The end consequence is insufficient cortisol production by the adrenal glands.
Causes of Tertiary Adrenal Insufficiency
- Stopping corticosteroids suddenly after consuming them for a long time is the most frequent cause of tertiary adrenal insufficiency.
- Tertiary adrenal insufficiency can develop after Cushing's disease has been treated. A hormonal disease called Cushing's syndrome is brought on by persistently high amounts of cortisol in the blood.
- Tumours in the pituitary or adrenal glands that produce too much ACTH or cortisol can occasionally be the cause of Cushing's syndrome. These tumours are often noncancerous.
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Symptoms of Adrenal Insufficiency
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The symptoms of Adrenal Insufficiency develop gradually and might also take several months to develop. Following are the symptoms of adrenal insufficiency:
- Fatigue
- Nausea or Vomiting
- Depression
- Weight Loss
- Painful Joints
- Abdominal Pain
- Muscle Weakness
- Decreased Appetite
- Low Blood Pressure
- Discolouration of Skin
- Irritability or Mood Swings
- More Cravings for Salty Foods
- Low Blood Sugar – Hypoglycemia
- Nausea, Diarrhea, and Other Gastrointestinal Symptoms
- Loss of Libido
- Dysmennorhea
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Diagnosis of Adrenal Insufficiency
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To diagnose Adrenal Insufficiency, awareness, knowledge of signs and symptoms, and endocrinological expertise is required. The doctor might order several tests for the individual to detect Adrenal Insufficiency.
Physical Tests
- Skin Discoloration Examination.
- Review medical records and family history.
- Patient’s blood pressure from sitting and standing positions.
Biochemical Laboratory Tests
- Blood tests to estimate electrolytes and hormones in the blood.
- ACTH stimulation to measure the level of cortisol in the blood.
- Insulin-induced hypoglycemia test – to test blood glucose and cortisol levels.
Imaging
- MRI scans of the pituitary gland.
- CT- Abdomen or computerised tomography of the abdomen region to estimate the change in the size of the patient’s adrenal glands.
Treatment of Adrenal Insufficiency
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Adrenal Insufficiency can be treated with the following treatments:
- Hormone Replacement Therapy: Oral medications are the first treatment of choice for Addison’s disease. Adrenal insufficiency is a hormonal disorder, and the treatment does involve balancing the steroid hormones in the patient. The patient must take the medication daily.
- Intravenous injections of Corticosteroids: The patient can be given intravenous injections for Adrenal insufficiency and other mineral deficiencies.
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Things to Remember
- Adrenal Insufficiency occurs when the Adrenal glands produce decreased levels of hormones.
- Adrenal Insufficiency affects people of all age groups and gender.
- It is of three types namely Primary, Secondary, and Tertiary Adrenal Insufficiency depending upon the cause.
- Primary Adrenal Insufficiency occurs when the adrenal gland itself is the causative factor.
- Secondary Adrenal Insufficiency occurs when the causative factor is other than the adrenal gland.
- The common symptoms of Addison’s Disease include Fatigue, Nausea or vomiting, Depression, Weight loss, Painful joints, and Abdominal pain.
Previous Years’ Quuestions
- Addisons disease results from… (AIIMS - 1998)
- Adrenaline directly affects on… (NEET - 2002)
- Hormones thyroxine, adrenaline and the pigment melanin… (NEET - 1997)
- Cortisol is secreted by the adrenal cortex in response to… (JKCET - 2012)
- Acromegaly is caused by… (NEET - 2002)
- Exophthalmic goitre is also called…
- A health disorder that results from the deficiency of thyroxine… (NEET - 2009)
- Which one of the following pairs correctly matches a hormone… (NEET - 2004)
- ADH or vasopressin is… (NEET - 1991)
- Graves disease is caused due to… (NEET - 2016)
Sample Questions
Ques. What is Adrenal Insufficiency? (2 Marks)
Ans. Adrenal Insufficiency is a disorder in which the body is unable to generate adequate levels of cortisol and, in rare circumstances, aldosterone. Adrenal Insufficiency often occurs as a result of injury to the adrenal glands, which generate these hormones (also known as Addison's disease). The inability of the brain to generate ACTH, the signal that controls adrenal function, can also result in adrenal insufficiency.
Ques. Discuss the Adrenal Cortex. (5 Marks)
Ans. Adrenal Cortex is the outside of the adrenal gland. It creates hormones to assist essential body processes and organ functioning. Adrenal cortex can be affected by a number of disorders. Some result in excessive hormone production, while others restrict it.
- Adrenal cortex can be divided into three layers, called zona reticularis (inner layer), zona fasciculata (middle layer), and zona glomerulosa (outer layer).
- It secretes many hormones that are commonly called corticoids.
- Glucocorticoid: The corticoids involved in carbohydrate metabolism are called glucocorticoids. Cortisol is the main glucocorticoid secreted in our body.
- Mineralocorticoids: Mineralocorticoids are responsible for water and electrolyte balance in our bodies. Aldosterone is the main mineralocorticoid in our body.
- In the first few weeks of pregnancy, adrenal cortex and the remainder of the adrenal gland develop. The foetal and adult definitive zones make up the gland's two current portions. After birth, the foetal zone contracts and eventually vanishes.
- The gland's growth is aided by the abundant blood supply, which enables it to create adrenal cortex hormones and connect to adjacent neurons.
Ques. Discuss functions of Aldosterone, cortisol, and sex steroids. (3 Marks)
Ans. Following are the functions of aldosterone, cortisol, and sex steroids:
Aldosterone
- Aldosterone increases sodium and water reabsorption in the kidneys.
- Causes excretion of potassium in the kidneys.
- Helps to maintain normal blood pressure
Cortisol
- Stimulates gluconeogenesis in the liver and helps to maintain normal glucose concentration in the blood.
- Stimulates lipolysis throughout the body
- Depresses the immune response
- Helps to decrease inflammation
Sex Steroids
They are mainly associated with the development of secondary sexual characteristics, for example, play a role in the growth of axial hair, pubic hair, and facial hair during puberty.
Ques. What are Endocrine Glands? (3 Marks)
Ans. Endocrine Glands are ductless glands. They secrete their respective hormones directly into the bloodstream which are required to regulate the functions of cells and tissues. The hormonal system (also known as the endocrine system in medical terminology) is made up of several glands that secrete various hormones.
The body's communication mechanism is similar to hormones. They transfer instructions from the gland to the target cell, instructing the target cell to carry out a vital task. Endocrine glands include
- Hypothalamus
- Pituitary Gland
- Pineal Gland
- Thyroid Gland.
- Parathyroid Glands
- Adrenal Glands
- Thymus
- Pancreas
Ques. What are the functions of the Adrenal Glands? (5 Marks)
Ans. Adrenal Glands have two parts namely the Cortex and the Medulla.
- Cortex is the outer part of the gland. It produces the hormones cortisol and aldosterone.
- Medulla is the inner part of the gland. It produces the hormones adrenaline and noradrenaline.
These four hormones are essential to normal functioning in the body. They control many important functions, including the following:
- Regulating Blood Pressure
- Responding to Stress
- Development of Sex Organs.
- Regulate Metabolism.
- Blood Sugar Levels.
- Salt and Water Balance
- Pregnancy
- Sexual Development Before and During Puberty
- Stress Response
Ques. What is Cortisol and what are its functions? (3 Marks)
Ans. Cortisol is a glucocorticoid hormone that is released by the adrenal glands at the time of stress. The two adrenal glands, one on top of each kidney, create the steroid hormone cortisol. More cortisol is produced in the circulation when a person is under stress. The health of a person depends on having the proper cortisol balance, and either too much or too little cortisol production can have negative effects on the body. Cortisol affects several areas of the body and serves a variety of crucial purposes. It can assist:
- Regulate the metabolism of fat, proteins, and carbohydrates.
- Supresses Inflammation.
- Regulates Blood Pressure.
- Increases Blood Sugar.
- Regulate the Sleep Cycle.
The "fight or flight" response, which is a healthy, normal reaction to perceived dangers, requires cortisol as well. The body regulates the quantity of cortisol generated to maintain the proper balance.
Ques. What is Aldosterone and what are its functions? (5 Marks)
Ans. Aldosterone is a mineralocorticoid released by the adrenal gland. It has the following functions:
- The main function of aldosterone is to assist in controlling blood pressure.
- Certain organs, such as kidneys and colon, are signalled by aldosterone to increase the quantity of sodium or potassium produced in the urine.
- The body retains water in the blood as a result of aldosterone's action on sodium elevation, increasing blood volume.
- When blood pressure levels fall, all of these procedures are necessary to raise them to a healthy range.
- Aldosterone indirectly contributes to the preservation of electrolyte levels and pH (acid-base balance) in the blood.
Ques. What are DHEA and Androgenic Steroids? What are its functions? (5 Marks)
Ans. DHEA is an endogenous steroid hormone. This indicates that it is produced by the body naturally and that it activates particular tissues or cells.
- The steroid hormone DHEA is one of the most prevalent in the human body.
- The brain, gonads, and adrenal glands all contribute to its production.
- It often appears as dehydroepiandrosterone sulphate (DHEAS).
- DHEAS is stored in the body as a reserve and is transformed into certain hormones when needed.
- DHEA and androgenic steroids are weak male hormones.
- They are converted into estrogen (female hormones) in the ovaries, and androgens (male hormones) in the testes.
- Though androgens are naturally thought of as male hormones, the female body produces a small number of androgens too.
Ques. What are Adrenaline and Noradrenaline? What are its functions? (3 Marks)
Ans. Adrenaline and Noradrenaline are known as “fight or flight” hormones. They are also called catecholamines and are released by the inner medulla. They have the following functions:
- They increase heart rate.
- Increase the blood flow to muscles and the brain.
- Assist in glucose metabolism.
- Control Vasoconstriction.
Ques. What are the functions of Steroid Hormones? (3 Marks)
Ans. Adrenal Cortex releases steroid hormones. Glucocorticoids, mineralocorticoids and adrenal androgens are all types of steroid hormones. It has the following functions.
- Control metabolism.
- Control Inflammation.
- Control Immune System Functions.
- Salt and Water Regulation.
- Development of Sexual characteristics.
- Ability to withstand injury or illness.
Ques. What other glands interact with the Adrenal Gland? (5 Marks)
Ans. The parts of the body interacting with adrenal glands are:
- Hypothalamus
- Pituitary Gland
- Kidneys
- Sympathetic Nervous System
Hypothalamus and Pituitary Gland plays a role in regulating adrenal glands. Corticotropin-releasing hormone (CRH) and antidiuretic hormone (ADH) are produced by the hypothalamus, a little region of the brain involved in hormonal control (ADH, or vasopressin).
Pituitary gland releases corticotropin (also known as adrenocorticotropic hormone or ACTH) in response to the production of ADH and CRH, which in turn stimulates the adrenal glands to generate corticosteroids like cortisol and aldosterone. Sympathetic nervous system controls the release of adrenaline and noradrenaline from adrenal glands, and the kidneys influence how much aldosterone the adrenal glands generate.
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