Adrenal Insufficiency, (Low Adrenal Hormones) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
By Kenneth Kee
()
About this ebook
Adrenal Insufficiency (Addison Disease) is a disease that is caused by the deficiency of circulating glucocorticosteroids and mineral corticoids (aldosterone) hormones as a result of disease of the adrenal glands.
Adrenal Insufficiency is a disorder in which the patient does not make enough cortisol and other hormones in the adrenal glands.
Different symptoms form if the cortisol value reaches too low a level.
A extremely low cortisol level can be threatening to life.
Causes:
1. Auto-immune disease (Type 1 PGA – Poly-glandular Autoimmune Syndrome) of the adrenals with destruction of the adrenal parenchyma is associated with circulating antibodies and decreased production of glucocorticosteroids.
2. Tuberculosis of the adrenal glands especially in developing countries
3. Adrenal tumors that may be benign or malignant can reduce production of corticosteroids.
4. Cancers of other parts of the body, which can spread and destroy the adrenals.
Symptoms:
In many cases the symptoms develop gradually over weeks or months
A person may feel tired and not right but it is difficult to say why.
Also most of the symptoms can be caused by other problems and Adrenal Insufficiency is rare.
So the condition may not be recognized for weeks or months after symptoms first begin.
1. General weakness and becoming easily tired.
2. Darkened areas of skin (pigmentation).
a. Sun-exposed areas of skin;
b. The armpits;
c. The nipples;
d. The creases of the hands;
e. Inside the mouth;
f. Recent scars and
g. Pressure points such as the elbows.
The reason for this is possibly because of the change in hormones which can involve the pigment cells in the skin.
3. Blood pressure which is low and falls further when a person stands which can make him or her dizzy.
4. Being off the food and weight loss.
5. Feeling sick and vomiting from time to time.
6. Abdominal pains which may come and go.
7. Diarrhea or constipation which may come and go.
8. Cramps and pains in muscles.
9. Craving for salt or salty foods and drinks.
10. Menstrual periods in women may become irregular or stop.
In Addison crisis symptoms are:
a. Severe vomiting and diarrhea,
b. Pains in the back and abdomen,
c. Dehydration,
d. Low blood pressure,
e. Collapse.
Diagnosis:
A one-off measurement of blood cortisol is not good enough to diagnose Adrenal Insufficiency.
ACTH stimulation test is normally needed to confirm the diagnosis.
Plasma cortisol is low (< 3mcg/dL) and do not rise with ACTH stimulation.
Other signs are hyperpigmentation and loss of weight.
Chest and abdominal X-rays are done to test for tuberculosis
Treatment:
1. Cortisol replacement
The person needs steroid medication to replace the cortisol which he or she no longer makes.
This is normally with a medicine called hydrocortisone which is very similar to cortisol.
The amount is normally about 15-30 mg each day.
2. Replacing aldosterone
Fludrocortisone is a substitute medicine for aldosterone.
This helps to regulate blood pressure and blood salt level.
3. Addison crisis is treated by intravenous normal saline and hydrocortisone 100mg every eight hours
In patients in acute adrenal crisis, IV access should be done urgently, and an infusion of isotonic sodium chloride solution
should be started to replace volume deficit and correct hypotension.
Some patients may need glucose supplements.
Parenteral steroid coverage should be given in times of major stress, trauma, or surgery and during any major procedure.
During surgical procedures, 100 mg of hydrocortisone should be given, preferably by the IM route, before the start of a continuous IV infusion
The normal daily hydrocortisone replacement dose should be titrated.
TABLE OF CONTENT
Introduction
Chapter 1 Adrenal Insufficiency
Chapter 2 Causes
Kenneth Kee
Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"
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Adrenal Insufficiency, (Low Adrenal Hormones) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee
Adrenal Insufficiency,
(Low Adrenal Hormones)
A
Simple
Guide
To
The Condition,
Diagnosis,
Treatment
And
Related Conditions
By
Dr Kenneth Kee
M.B.,B.S. (Singapore)
Ph.D (Healthcare Administration)
Copyright Kenneth Kee 2017 Smashwords Edition
Published by Kenneth Kee at Smashwords.com
Dedication
This book is dedicated
To my wife Dorothy
And my children
Carolyn, Grace
And Kelvin
This book describes Adrenal Insufficiency, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.
(What The patient Need to Treat Adrenal Insufficiency)
This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If the patient would like to share this book with another person, please purchase an additional copy for each reader.
If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.
Thank the patient for respecting the hard work of this author.
Introduction
I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.
My purpose in writing these simple guides was for the health education of my patients.
Health Education was also my dissertation for my Ph.D (Healthcare Administration).
I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.
This autobiolographical account A Family Doctor’s Tale
was combined with my early A Simple Guide to Medical Disorders
into a new Wordpress Blog A Family Doctor’s Tale
on http://kenkee481.wordpress.com.
From which many free articles from the blog was taken and put together into 800 amazon kindle books and 200 into Smashwords.com eBooks.
Some people have complained that the simple guides are too simple.
For their information they are made simple in order to educate the patients.
The later books go into more details of medical disorders.
The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.
Since 2013, I have tried to improve my spelling and writing.
As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.
Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.
I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.
I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.
I apologize if these repetitions are irritating to some readers.
Chapter 1
Adrenal Insufficiency (Addison Disease)
What is Adrenal Insufficiency?
Adrenal Insufficiency (Addison Disease) is a disease that is caused by the deficiency of circulating glucocorticosteroids and mineral corticoids (aldosterone) hormones as a result of disease of the adrenal glands.
Adrenal Insufficiency is a disorder in which the patient does not make enough cortisol and other hormones in the adrenal glands.
Different symptoms form if the cortisol value reaches too low a level.
A extremely low cortisol level can be threatening to life.
Treatment is with replacement hormone tablets which the patient need to take every day.
Incidence:
Adrenal Insufficiency is not common (about 4 per million per year) and appears by the age of 15 years.
Most cases first develop in people aged between 30 and 50 but it can occur at any age.
Pathophysiology
Every person has two small adrenal glands that are located just above each kidney.
Each adrenal gland has an outer part (adrenal cortex) and an inner part (adrenal medulla).
Cells in the adrenal glands make various hormones.
A hormone is a chemical which is made in one part of the body but passes into the bloodstream and has effects on other parts of the body.
The cells in the adrenal cortex (the outer portion of the adrenals) produce the hormones cortisol and aldosterone.
The amount of cortisol that is made is controlled by another hormone called adrenocorticotrophic hormone (ACTH).
ACTH is produced in the pituitary gland (a small gland located just under the brain).
ACTH passes into the bloodstream is carried to the adrenal glands and stimulates the adrenal glands to make cortisol.
Cortisol is a hormone that is vital for health.
It has many functions which assist to:
a. Regulate blood pressure.
b. Regulate the immune system.
c. Equalize the effect of insulin in regulating the blood sugar level.
d. Prepare the body to respond to stress.
Aldosterone helps to