Among the most common disorders associated with impaired function of adrenal hormones are hyperfunction and hypofunction. At the first violation, hormones are produced in excess, while the second, on the contrary, loses the ability to synthesize hormones in the right amount. About the main diseases of the adrenal cortex and methods read in this article.
Neuroendocrine glands of the adrenal glands and the action of their main hormones
Adrenals are small paired internal secretion organs located above the upper poles of the kidneys and together with the kidneys located in the retroperitoneal space.
Below you will learn about the functions of the hormones of the adrenal glands and the treatment of diseases svejanyh with a violation of their production.
Adrenals are neuroendocrine glands, more precisely, each of them contains just 2 glands "inserted into each other".The adrenal medulla produces epinephrine and norepinephrine - neurotransmitters. These hormones of adrenal medulla are involved in numerous reactions of the nervous system.
The cortical substance of the adrenal glands is a purely endocrine organ. It is separated into 3 layers. What hormones are produced by the adrenal glands in the glomerular layer of the cortex? It synthesizes aldosterone - a hormone that regulates water-salt metabolism and blood pressure. Also, hormones of the adrenal glands are cortisol and other glucocorticoids, which are produced in the beam and reticular zones.
Cortisol is responsible for carbohydrate metabolism and some of the sex hormones that have androgenic activity and are responsible for the growth of core hair in women and men.
What hormones produce the adrenal medulla: glucocorticoids
The main functions of hormones of the adrenal cortex of glucocorticoids:
- Causes an increase in the concentration of glucose in the blood in several ways: by reducing the capture of glucose by tissues( direct antagonism to insulin), which in turn causes compensatory release of insulin by the pancreasaccount stimulation of the processes of gluconeogenesis from amino acids and glycerin and by stimulating the synthesis of glycogen.
- Also these hormones of the adrenal cortex inhibit the capture of glucose and enhance lipolysis( fat decomposition) - these processes are more active on the extremities, where the adipose tissue receptors are sensitive to glucocorticoids. As a result, the fat content on the limbs decreases.
- On the body fat tissue is more sensitive to the action of insulin, and therefore in its cells under the influence of hyperinsulinemia, lipogenesis( fat synthesis) is intensified. Under their influence, the fat is redistributed in the body: the person lays fat on the chest, abdomen, buttocks, the face is rounded, on the back of the neck appears "bull's withers."At the same time, the limbs of such people are practically devoid of fat.
- Adrenal gland hormones increase the breakdown of proteins in the tissues of muscles, skin, connective, fat and lymphoid tissue( lymph nodes, thymus gland, spleen).
- Also the role of hormones in the adrenal glands lies in a powerful anti-inflammatory effect.
- In the production of adrenal hormones, receptors are activated for mineralocorticoids( although to a lesser extent than mineralocorticoid hormones).As a result, the body retains fluid, pressure rises, and the volume of circulating blood increases.
Adrenal development of hormones of mineralocorticoids and their action
Mineralocorticoids are vital hormones. The death of the body after removal of the adrenals can be prevented only by injecting hormones from the outside.
Aldosterone supports optimal water-salt exchange between the external and internal environment of the body. One of the main organs - the targets of the hormone are the kidneys, where aldosterone causes the absorption of sodium with its delay in the body and increases the release of potassium in the urine. In addition, together with sodium in the kidney water is retained, which leads to an increase in the volume of circulating blood and increased pressure. Acting on the cells of blood vessels and tissues, this one of the main hormones of the adrenals promotes the transport of sodium and water into the intracellular space. With tumors of the glomerular zone of the adrenal cortex, the adrenal gland starts to work autonomously, and the aldosterone work regimen is upset.
Sex hormones that secrete the adrenal glands
Sex hormones that excrete the adrenal glands regulate the growth of the shaft hair in the axilla and pubic region, which begins in the late stages of puberty. Excessive growth of these hair can indicate violations of the adrenal cortex. During the period of intrauterine development, these hormones can affect the formation of the external genitalia. For example, if the production of glucocorticoids sharply decreases due to impairment of the action of adrenal hormones, the pituitary gland, trying to compensate for this deficiency, begins to increase the production of ACTH.However, this sex hormone of the adrenal glands stimulates not only the production of glucocorticoids, but also the production of androgens. In this case, the girl with a genetically female sex, uterus and ovaries external genital organs may be formed according to the male type. Sometimes such a patient with a malfunction in the development of sex hormones of the adrenal glands is mistakenly attributed at birth to the male sex.
Diagnostics. To determine the functional state and identify diseases associated with adrenal hormones, examine the level of glucocorticoids in the blood or products of their metabolism - 17-ketosteroid in the urine. The status of the mineralocorticoid function of the adrenal glands is judged by the content and the ratio of potassium and sodium in the blood. To assess the autonomy of the gland, functional tests are used: a sample with a water load( with hyperaldosteronism), a test with the introduction of ACTH.
Hyperfunction of the adrenal cortex: symptoms and treatment
Hyperfunction of the adrenal cortex can be either a consequence of the disease or a side effect of medications.
The cause is a tumor of the adrenal cortex that produces many glucocorticoids.
Symptoms. In patients with increased production of adrenal hormones, the pressure increases, obesity develops in the central type and diabetes, muscle weakness grows, and the skin becomes thin and dry. Brittle and brittle bones become, as glucocorticoids are able to activate parathyroid hormone and wash calcium out of bones. In high doses, glucocorticoids can provoke the development of stomach ulcers. Women may have menstrual irregularities and infertility.
In urine, the levels of 17-X and 17-ACS are elevated, in the blood - high levels of testosterone and cortisol. The excretion of the hormone of the adrenal cortisol is evenly high in the morning, and at noon, and in the evening( normally the maximum of these hormones enters the blood in the morning, by midday their concentration in the blood drops by half, and by the evening there are very few of them).On the radiographs of bones - the phenomenon of osteoporosis.
Diagnostics. The final diagnosis is established after tomography of the pituitary and adrenal glands.
Treatment is prompt, the damaged adrenal gland is removed. After surgical treatment of the disease of the adrenal cortex, the patient's condition is restored.
Treatment of dysfunction of the adrenal cortex with glucocorticoids
The same effects can be observed with prolonged treatment with artificial analogs of glucocorticoids of chronic inflammatory, allergic and autoimmune diseases( for example, in rheumatoid arthritis, bronchial asthma and so on).Patients develop centralized obesity, increased pressure, hyperacid gastritis or stomach ulcers, impaired carbohydrate metabolism( pre-diabetes) or real type II diabetes, increased bone fragility due to calcium leaching out of them, women develop male-type hair, disordersmenstrual cycle, infertility. Long-term administration of glucocorticoids( cortisone and its analogues) to the body can lead to suppression and atrophy of the adrenal cortex, as well as to inhibit the formation of not only ACTH, but also gonadotropic and thyrotropic hormones of the pituitary gland.
However, if a patient is prescribed long-term glucocorticoid therapy due to a severe chronic illness and he does not want to face problems, it is necessary to take preventive measures during admission: adherence to a low-carb diet, taking a complex of vitamins and mineral supplements, taking drugs that protect the gastric mucosa. Specific drugs and schemes are discussed with the attending physician.
For the treatment of pre-diabetes and restoration of glucose metabolism, improvement of skin and hair condition is prescribed a diet with restriction of carbohydrates and increased protein content.
For the restoration of the bone structure of , adrenal cortex dysfunction is prescribed a combined preparation of calcium and vitamin D3.
To restore the gastric mucosa - special gastroenterological drugs.
Increased secretion of adrenal hormones hyperaldosteronism: diagnosis and treatment
Hyperaldosteronism is a condition in which the adrenal cortex secrets more aldosterone than is required in order to maintain the sodium-potassium equilibrium.
Excessive production of aldosterone leads to a delay in the body of sodium and water, edema and increased blood pressure, loss of potassium and hydrogen ions, resulting in disturbances in the excitability of the nervous system and the myocardium.
Primary hyperaldosteronism when the adrenal cortex function is abnormal develops with the adrenal adenoma producing aldosterone( the so-called Kon syndrome), or with bilateral hyperplasia of the adrenal cortex. With secondary hyperaldosteronism, aldosterone in the blood rises due to dysfunctions of other organs( for example, renal hypersecretion of renin, hypersecretion of ACTH, and others).
Diagnostics. It is determined constantly high blood pressure, high sodium level and low level of potassium in the blood. For differential diagnosis of various forms of hyperaldosteronism, a number of functional tests are used.
Treatment. In case of tumor forms only operative, in other cases conservative treatment with diuretics is prescribed.
Chronic adrenal insufficiency: symptoms and treatment
Chronic adrenal insufficiency or Addison's disease - this pathological condition was first described by British therapist Thomas Addison in his 1855 publication. Addison's disease( chronic insufficiency of the adrenal cortex, or hypocorticism, bronze disease) is a rare endocrine disease that affects 90% of the adrenal cortex and it loses the ability to produce enough hormones, especially cortisol.
The most common cause of insufficiency of the adrenal cortex is an autoimmune process, also in some cases the adrenal glands can infect tuberculosis, fungal diseases( histoplasmosis, blastomycosis, coccidioidomycosis), tumors, hemorrhages in the cortical layer of adrenal glands. With adrenal insufficiency, atrophy of the adrenal cortex can develop as a result of prolonged therapy with synthetic glucocorticoids, and, finally, the adrenal glands can be damaged or removed during kidney surgery.
Similar symptoms can develop with pituitary insufficiency due to discontinuation of adrenal stimulation of ACTH.
Symptoms. Weakness, fatigue, especially after physical exertion or stressful situations, worsening appetite. Also, the symptoms of adrenal insufficiency is a decrease in the general tone of the body.
Gradually appears a light yellowish-brown skin tint, similar to sunburn, however, in contrast to sunburn, the coloring of nipples, lips, cheeks also intensifies.
A serious symptom is a persistent drop in blood pressure, further decreasing in the standing position( orthostatic hypotension).
Digestion disorders often occur: nausea, vomiting, constipation, alternating diarrhea.
Patients note a craving for salt and salty food, thirst, they have violations of attention, memory, depressive states, irritability, short temper, depression.
Women lose pubic hair and armpits, menstrual cycle is broken, men develop impotence.
In severe cases, convulsive seizures occur due to a violation of calcium metabolism in the body( especially after drinking milk), paresthesia( sensitivity disorder), sometimes up to paralysis, tremors( trembling of the hands, head) and swallowing. Dehydration of the body develops. This condition is life-threatening and requires immediate hospitalization.
Diagnostics. It is carried out on the basis of complaints and appearance of patients, persistent decrease in arterial pressure, poor tolerance of physical exertion. In the blood of patients are found: a low level of cortisol, high levels of potassium and urea, low sodium and glucose, high levels of ACTH( which causes skin coloration due to the affinity of ACTH with melatonin).In pituitary lesions, the ACTH level is below normal. Sometimes you can identify antibodies in adrenal tissue.
Treatment. Lifetime replacement therapy with adrenal hormones is prescribed. The patient is recommended to eat food that contains enough protein, fats, carbohydrates and vitamins, especially C and B( recommend boiling dogrose, black currant, brewer's yeast).The salt is consumed in an increased amount( 20 g / day).In this disease, associated with a malfunction in the production of adrenal hormones, treatment is impossible without a balanced diet. It is necessary to reduce the amount of potatoes, peas, beans, beans, dried fruits, coffee, cocoa, chocolate, nuts, and mushrooms consumed.
Vegetables, meat, fish should be eaten in boiled form. The diet during the treatment of adrenal insufficiency is fractional, before going to bed recommend a light snack( a glass of milk).
Adrenocortical insufficiency hypoaldosteronism
Disease in which the adrenal glands do not produce enough aldosterone. Primary hypoaldosteronism, most likely, is caused by a congenital deficiency of enzyme systems controlling the synthesis of aldosterone in the last stages. It is detected in infants or in early childhood.
The defect of aldosterone biosynthesis may appear with the continued or prolonged use of a number of drugs.
Secondary hypoaldosteronism is associated with inadequate renin production by the kidneys or the release of inactive renin. This form often accompanies and complicates the course of diseases such as diabetes mellitus, chronic nephritis with renal tubular acidosis.
Symptoms. It is observed predominantly in men. Patients complain of general and muscle weakness, constantly low blood pressure and a rare pulse, dizziness, a tendency to fainting. Also, the symptoms of adrenal cortex disease are a violation of the rhythm of breathing, right up to attacks with confusion and convulsions.
Diagnostics. Low aldosterone, hyperkalemia, sometimes hyponatremia, normal or elevated cortisol levels are found in the blood. On the ECG, signs of hyperkalemia are recorded: lengthening of the PQ interval, bradycardia, this or that degree of transverse blockage, high acute pincer in the thoracic leads.
Treatment. Introduction of sodium chloride and liquid, preparations of synthetic mineralocorticoids for replacement therapy. Therapy continues for life.
Phytotherapy for disorders of the adrenal cortex
Herbal preparations are used for hyperfunction of the adrenal cortex with the development of violations of carbohydrate metabolism. Phytotherapy helps to normalize blood sugar and avoid the development of diabetes.
Herbal preparations, decoctions and infusions can be used only as an auxiliary therapy and only under the supervision of a doctor.
1 tbsp.l.chopped dandelion root pour 1 cup boiling water and cook for 15 minutes. Infuse 2 hours. Take 1/4 glasses before meals 3 times a day.
1 tbsp.l.crushed birch leaves pour 1 cup boiling water and cook for 10 minutes. Infuse 6 hours. Strain and take 1/3 cup 3 times a day with meals.
Burdock roots of large
1 dessert l.chopped root burdock large pour 300 ml of water and cook for 15 minutes. Infuse for 30 minutes. Strain and take 1 tbsp.l.3-4 times a day after meals.
Stems of oats
1 tbsp.l.shredded stalks of oats pour 300 ml of boiling water and cook for 15 minutes. Infuse 3-4 hours. Take 1/2 cup 3 times daily before meals.