Adrenal insufficiency is a disease of the endocrine system in which the adrenal glands, located on top of each kidney, do not make enough hormones. There are two types of adrenal insufficiency: primary and secondary. Primary adrenal insufficiency is referred to as Addison’s disease, where the glands are damaged and do not synthesize enough cortisol and aldosterone. These hormones are important for regulating blood pressure and metabolism and are also key responders to stress. Secondary adrenal insufficiency is the most common kind. This begins in the pea-sized pituitary gland located in the brainstem. With this type, the pituitary gland does not make adrenocorticotropin (ACTH) which is necessary for the adrenal glands to produce cortisol. The lack of these hormones causes many symptoms.
Hyperpigmentation occurs only with Addison’s disease, which, as mentioned, is the primary form of adrenal insufficiency. Since Addison’s disease involves damaged adrenal glands that do not make enough hormones, the pituitary gland responds by making more of the adrenal-stimulating hormone ACTH. ACTH is directly involved in making melanin, the hormone responsible for darkening the skin. As melanin increases in the body, it causes darkening of the skin. It is often seen around joints, scar tissue, and mucous membranes. It can also cause the lips, rectum, and lining of the mouth to turn a bluish-black color. Black freckles are usually found on the face, neck, and shoulders. Areas of the body not normally in the sunlight will still darken, but parts of the body in the sunlight will become even darker.
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Hypoglycemia is the condition in which the body’s blood sugar level plummets. A person can feel shaky, dizzy, nauseated, fatigued, or have tunnel vision. Feeling like one is about to faint is a common symptom of low blood sugar. Cortisol, in part, is responsible for helping the liver change its stored sugars into blood sugars to provide energy. In adrenal insufficiency, low levels of cortisol make the liver unable to convert these sugars and blood sugar levels drop. This condition is exacerbated during stress because the body has an increased need to use those stored sugars. Cortisol is normally released during stressful scenarios, and without it, the body is unable to generate energy.
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Nausea And Vomiting
Nausea, which is feeling the impending need to vomit, can be felt in the upper abdomen, chest, and throat. Vomiting is the involuntary action of the stomach to force its contents out of the body through the mouth. Nausea and vomiting, present in about fifty percent of those with adrenal insufficiency, accompany one another as nausea often precedes vomiting. Some medicines can ease the discomfort of nausea and sometimes stop vomiting. Vomiting is usually a sign that the disease has progressed. The body’s gag reflex and couching protect it from aspirating vomit, but these protections can fail in cases of unconsciousness. It is important to roll an unconscious vomiting person on their side to lessen this possibility.
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With lowered production of homeostasis-regulating hormones, extreme fatigue is common with both types of adrenal insufficiency. It is characterized by weakness, sleepiness, and general malaise. One might wake up every morning with the feeling of not having slept at all. It might be difficult for an individual to get out of bed, go to work, and complete simple daily activities. Fatigue is a continuous feeling, and it does not come and go with activity level. There is usually no obvious reason an individual would feel fatigued such as extreme exercising or not sleeping. Without being able to participate in regular activities, fatigue can lead to anxiety and depression.
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Low Blood Pressure
Low blood pressure is more common in Addison’s disease rather than type 2 adrenal insufficiency. Low blood pressure means anything under 90/60 and is caused by low levels of aldosterone in the blood. Aldosterone helps to moderate blood pressure by controlling sodium and potassium in the body. If sodium is too low, aldosterone signals to the kidneys to add more to the blood. If potassium is too high, it signals to the kidneys to release it in urine. Symptoms of this condition include lightheadedness, dizziness, blurred vision, fainting, and nausea. In some cases, there may be no symptoms at all.