Generality
Adrenal insufficiency is a disorder characterized by severely impaired adrenal activity.
The adrenals are glands responsible for the synthesis of hormones such as androgens, glucocorticoids (the progenitor of which is cortisol) and mineralocorticoids (whose progenitor is aldosterone). Therefore, their dysfunction causes a deficiency of one or more of the aforementioned hormonal classes within the body.
Basically, there are three types of adrenal insufficiency: primary, secondary and tertiary.
Causes
In the case of primary adrenal insufficiency, the triggering cause lies in intrinsic damage of the adrenal gland, which fails to produce sufficient quantities of cortisol, despite the presence of normal levels of ACTH (adrenocorticotropic hormone that stimulates the synthesis of cortisol in the adrenal) This form of "adrenal insufficiency is also known as" Addison's disease ".
In the case of secondary adrenal insufficiency, however, the cause is to be found at the level of the pituitary gland (the gland secreting ACTH). Therefore, in this case the adrenal compromise is due to the lack of the stimuli induced by the adrenocorticotropic hormone, necessary for the production of cortisol. The secondary form is more common than Addison's disease and can be caused by abruptly stopping any corticosteroid treatment or by the removal of ACTH-secreting tumors.
In other cases, however, secondary adrenal insufficiency can develop due to pituitary tumors, due to a possible radiotherapy performed at the pituitary level, or following the surgical removal of the pituitary gland itself.
Finally, the tertiary form of adrenal insufficiency is caused by a dysfunction in the hypothalamus that does not secrete enough CRH (corticotropin releasing hormone). This hormone, in fact, is the one that stimulates the pituitary to produce ACTH which - in turn - will stimulate the adrenal glands to secrete cortisol. However, the latter form is quite rare.
Symptoms
The symptoms that may occur in patients with adrenal insufficiency are related to the deficiency of the hormonal classes mentioned above. These symptoms include: dehydration, hypoglycemia, hypotension, dizziness, weakness, nausea and vomiting, diarrhea, weight loss, decreased pubic and axillary hair in women and decreased libido.
The information on Adrenal Insufficiency - Drugs and Care is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Adrenal Insufficiency - Drugs and Treatment.
Medicines
The treatment of adrenal insufficiency is based on substitution therapy, ie the administration of the synthetic forms of hormones that the adrenal glands are no longer able to produce.
In the case of primary adrenal insufficiency, glucocorticoids and mineralocorticoids are administered, as well as androgen substitutes. For more detailed information about Addison's bite therapy, please refer to the "dedicated article already present on this site (" Drugs for Addison ").
In the treatment of secondary and tertiary forms of adrenal insufficiency, however, mineralocorticoids are not used, since the deficiency of the adrenocorticotropic hormone typical of these forms does not affect the synthesis of aldosterone (progenitor, in fact, of mineralocorticoids), but only that of cortisol . Therefore, the replacement therapy will mostly be based on the administration of glucocorticoid drugs.
Generally, glucocorticoids are administered orally, but - if necessary - the doctor may decide to administer them also - or alternatively - intramuscularly.
The following are the drugs most used in the therapy against secondary and tertiary adrenal insufficiency and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state health of the patient and his response to treatment.
Hydrocortisone
Hydrocortisone (Plenadren ®) is one of the glucocorticoids of first choice for the treatment of adrenal insufficiency. When administered orally, it is always recommended to take the drug at least 30 minutes before breakfast and, preferably, between 6.00 and 8.00 in the morning.
The dose of drug to be taken must be established by the physician on an individual basis for each patient. Although, usually, the optimal dosage is between 20 and 30 mg of active ingredient per day.
Furthermore, in the case of conditions of severe physical stress, in the presence of infections or in case of surgical interventions, the doctor may consider it necessary to increase the dose of hydrocortisone usually administered.
Cortisone
Cortisone (Cortone Acetate ®) is also one of the first choice drugs in the replacement therapy of adrenal insufficiency. It is available for oral administration in the form of tablets.
The dose of cortisone usually used in the treatment of adrenal insufficiency is 10-20 mg per day. In some cases, however, larger amounts of the drug may be required.
In addition, usually, 4-6 g of sodium chloride is also administered concurrently with cortisone therapy.
In any case, the exact dosage of the drug must always be established by the doctor according to the patient's condition and his response to the treatment itself.
Dexamethasone
Although not one of the first choice glucocorticoids, dexamethasone (Decadron ®) can also be used in the replacement treatment of adrenal insufficiency.
It is available in different pharmaceutical formulations suitable for different routes of administration.
When administered orally, it is generally recommended to start therapy with low doses of the drug (0.5-1 mg per day). Thereafter, the doctor may gradually increase the amount of dexamethasone administered until the minimum effective dose is reached for each patient. Therefore, even in this case, the dosage of the medicinal product should be determined on an individual basis.
