What Is Adrenal Insufficiency?
The adrenals are the body’s first line of response to stress, but if continually called upon to release their steroids, they can slowly become worn out and underactive.
What are the Adrenals?
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The adrenal cortex is part of the HPA (hypothalamic-pituitary-adrenal axis), which is the control centre for most of the body’s hormonal systems. The adrenals’ role is to respond to stress messages from the brain by releasing steroid hormones. (1)
The outer layer of the adrenal cortex (zona glomerulosa) produces the mineralocorticoids, which primarily regulate blood volume, and water and salt balance.
A deeper layer – the zona fasciculata – produces the glucocorticoids, which influence cell energy balance, and maintain cardiovascular, metabolic and immune equilibrium. All cells appear to have glucocorticoid receptors – so these steroid hormones play a huge role within every part of the body and its systems.
The two main effects of the glucocorticoids are the ability to form glucose from non-sugar sources, and to maintain the muscle tone of the arteries, thus regulating blood pressure. Cortisol (aka hydrocortisone), the stress hormone, is a glucocorticoid.
The final inner layer (zona reticularis) produces androgens (the sex hormones). It also produces anabolic steroids, including DHEA (dehydroepiandrosterone).
What is Adrenal Insufficiency?
Cortisol is the main representative of the glucocorticoids, and this is the hormone that helps the body deal with stress, both long- and short-term. This vital hormone is famous for helping the body deal with stress and inflammation, but it is also essential for the correct functioning of the immune system, and the body’s use of carbohydrates, fats, and proteins.
Virtually any type of physical or mental stress leads to an elevation of cortisol concentrations in the blood (due to increased secretion of CRH in the hypothalamus). Chronic, long-term stress can therefore result in low adrenal reserve, made worse if thyroid hormone production is also low (hypothyroidism), as the adrenal glands have to work harder to make up for the lower thyroid output – which is itself a stress situation. If extreme stress continues long-term, or thyroid deficiency remains untreated, the adrenals are unable to maintain this higher output, and eventually become exhausted. The body is now said to be in a state of adrenal exhaustion, low adrenal reserve, or adrenal insufficiency.
Signs include extreme tiredness, especially as the day wears on; slow recovery from minor illnesses; hypoglycaemia (feelings of faintness relieved only by sugar); “roller-coaster” temperature, veering between hot and cold; poor nutrient absorption. There may be dark circles under the eyes, patches of darkening skin pigmentation, hair loss, and bowel problems, including IBS (irritable bowel syndrome).
The Thyroid Connection
Adrenal insufficiency can be mistaken for hypothyroidism, as the symptoms are very similar. However, if thyroid hormone replacement treatment (Levothyroxine) is started without addressing any adrenal insufficiency, the treatment will be at best ineffective, and at worst, potentially lethal. See Hypothyroidism and the Adrenals.
Addison’s Disease (Hypoadrenocorticism)
The worst form of adrenal insufficiency is Addison’s disease: a rare, chronic condition brought about by the failure of the adrenal glands. Worldwide, it is most often caused by TB, but it can also be caused by adrenal cancer or adrenal haemorrhage, HIV (AIDS), or – most commonly in developed countries – by an over-active immune system attacking the body’s own organs. This is known as autoimmune adrenalitis, and it is often associated with other autoimmune diseases, and endocrine disorders such as hypothyroidism and hyperthyroidism.
Over the course of many years, Addison’s disease causes primary adrenal insufficiency (the adrenal glands themselves become dysfunctional). Symptoms of the advanced disease can include: severe fatigue and weakness, weight loss, increasing areas of skin pigmentation, low blood pressure, fainting, nausea, vomiting, salt cravings, and painful muscles and joints. Salt craving may be the first sign of autoimmune adrenal destruction. (2)