Adrenal Insufficiency Treatment

Adrenal insufficiency is a term used to describe two different disorders affecting hormone production in the adrenal glands. Addison's disease, also known as primary adrenal insufficiency, occurs when the adrenal glands are damaged. Secondary adrenal insufficiency occurs when the associated pituitary gland creates insufficient amounts of a substance that stimulates the adrenal glands. Treatment for adrenal insufficiency requires replacement of any missing hormones, as well as protection against emergency disruptions of adrenal function.

Understanding Adrenal Insufficiency

• Your adrenal glands produce two important hormones. Cortisol, which belongs to a group of substances called glucocorticoids, helps regulate your body's metabolism of carbohydrates, proteins and fats; slows inflammatory response in your immune system; maintains glucose levels in your blood and regulates blood pressure and your body's cardiovascular system. Aldosterone, which belongs to a group of substances called mineralocorticoids, helps maintain your kidney function and blood pressure. If you have Addison's disease, which is caused primarily by autoimmune attacks on otherwise healthy adrenal glands, both cortisol and aldosterone production are affected. If you have secondary adrenal insufficiency, the causes of which include pituitary gland surgery, cortisol production drops, although aldosterone production usually is unaffected.

Main Treatments

• According to the National Endocrine and Metabolic Diseases Information Service, if you are diagnosed with secondary adrenal insufficiency, your doctor will try to replace your missing cortisol with related synthetic glucocorticoids. Examples include prednisone, hydrocortisone and dexamethasone. Your daily dosages of these medications will vary according to the particular treatment your doctor prescribes. If you have Addison's disease, you also will receive treatment with a synthetic mineralocorticoid called fludrocortisone acetate (Florinef). Your doctor probably will recommend that you increase your daily salt intake. Life-long treatment with substitute hormones is usual, and it is vitally important that you do not skip doses of any medication your doctor prescribes.

Treating and Preventing Acute Adrenal Failure

• In some cases, the symptoms of Addison's disease can appear quite suddenly. Signs of this life-threatening circumstance---referred to as Addisonian crisis or acute adrenal failure---include severe diarrhea and vomiting; low blood pressure; pain in your abdomen, lower back or legs; abnormally high potassium levels and loss of consciousness. If you develop these symptoms, you require immediate treatment involving an intravenous injection of dextrose, saline solution and glucocorticoids.

  To avoid potentially fatal crises when you are out of reach of rapid medical care, your doctor may recommend you carry an emergency supply of hydrocortisone that you can self-inject if necessary. Always carry a medical identification card that describes your illness and the medicines required to treat it, as well as the name, telephone number and address of your doctor.

Additional Considerations

• If you become seriously ill, your treatment levels may be adjusted to allow your body to respond to sickness as it would under normal circumstances. If you need surgery that involves any kind of anesthetic, tell your surgeon about your adrenal problems. He will provide you with an intravenous drip of glucocorticoids and saline during your procedure. If you are pregnant, tell your doctor about your adrenal condition.