Causes and symptoms of chronic adrenal insufficiency

Chronic adrenal insufficiency is a condition in which a decrease in glucocorticoid or mineralocorticoid hormones, or both, is caused by a variety of factors. The disease occurs slowly over a long time before showing symptoms.

Primary adrenal insufficiency due to autoimmune causes: Causes destruction of cell organization in the adrenal cortex and some other organs of the patient.
Tuberculosis of the adrenal glands: Mostly common in the 20s and 30s, in underdeveloped countries. It is rare these days that adrenal insufficiency is caused by tuberculosis. Adrenal destruction: Bilateral adrenalectomy for Cushing's disease or Mitotan (op'DDD) for adrenal cancer. Other rare causes: Fungal infection, HIV infection, syphilis causing adrenal necrosis. Adrenal hemorrhage due to coagulopathy, treatment with anticoagulants, bilateral adrenal infarction, arteritis, sepsis, septic shock... Invasive infiltrative diseases of the adrenal gland such as: Iron infection, sarcoidose, metastatic cancer... Congenital adrenal degeneration, adrenal white matter dystrophy (rare). Gene disorder.

Prolonged use of exogenous glucocorticoid hormones. Pituitary or hypothalamic tumor: Pituitary tumor, craniopharyngeal tumor, rathke cyst, pituitary stalk lesion. Skull injury. Lymphatic pituitary inflammation. Abnormalities of the pituitary gland due to genetic mutations. Infections: Tuberculosis, cancer metastasis, neurosarcoidosis. Cerebral infarction, cerebral bleeding: Sheehan's disease, aneurysm. Isolated ACTH hormone deficiency. Familial cortisol-binding globulin deficiency.

Chronic adrenal insufficiency often occurs slowly over a long period of time before symptoms appear, so the disease is often diagnosed late. It is not until 90% of the adrenal cortex is destroyed that symptoms become apparent. Especially when there are favorable factors such as: stress, infection, surgery, trauma, there will be an acute adrenal crisis.
Fatigue is a very common symptom and often appears early but is easily overlooked, physically, mentally and sexually. Fatigue usually appears when you first wake up, less tired in the morning than in the afternoon. Fatigue increases gradually with the rate of exertion, sometimes the patient cannot walk. Fatigue leads to sluggishness, apathy and depression. Women will have symptoms of frigidity, amenorrhea due to exhaustion rather than ovarian failure, and hair loss due to decreased androgen secretion. Male hypogonadism accounts for 4-17%. Slowly losing weight (2-10kg) due to dehydration accompanied by impaired gastrointestinal function, anorexia, poor appetite. Gastrointestinal disorders: Non-localized abdominal pain may be confused with acute surgical disease. Nausea, vomiting, diarrhea aggravate the condition. Digestive disorders due to water and electrolyte disturbances, decreased gastric secretion.

Melasma: Typical bronze-brown tan, tanning in open skin (exposure to sunlight), frequently rubbed skin, new scarred skin. Specifically, the folds of the hands, feet, knees, toes, and elbow joints are brown or black. The nipples and mucous membranes of the genitals are darkened. The cheeks, gums, floor of the mouth and the inside of the cheeks have black spots. Hypotension is very common, accounting for 90% of cases, depending on the duration of the disease and the degree of adrenal damage. Postural hypotension may occur. Weak pulse, stuck blood pressure, cardiogenic shock. The patient's heart is usually smaller than normal. Hypoglycemia is common in children. Symptoms of hypoglycemia are common when a person skips or overeats, has a fever, an infection, or is vomiting. Chronic adrenal insufficiency of secondary causes is more common with symptoms of hypoglycemia than chronic adrenal insufficiency of primary causes. Neuropsychiatric symptoms: Restlessness, apathy or confusion, inability to concentrate, alternating periods of somnolence, lethargy, and nervous excitability, rarely. Joint pain, muscle pain, and cramps may also occur. Note the factors that can cause decompensation of adrenal insufficiency: Arbitrary discontinuation of treatment. Low salt diet, high exercise, vomiting, defecation, sweating lead to loss of salt, infection, trauma, surgery. Use diuretics, sedatives, contrast agents. Pregnant.

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