Adrenal dysfunction. Tired Man, continued...

Functions of the adrenal glands

The cortex produces steroid hormones that control energy exchange and metabolism. There are three zones of the cortex, each of which synthesizes different hormones:

• zona glomerulosa - produces aldosterone, which affects water-salt metabolism and maintains blood pressure;
• reticular zone - sex hormones are synthesized that influence the formation of secondary sexual characteristics;
• zona fasciculata - glucocorticoids are produced, which are responsible for regulating protein, carbohydrate, fat metabolism, as well as nucleic acid metabolism. These hormones are also responsible for the body’s adaptation to stressful situations.

Catecholamines (adrenaline, dopamine, norepinephrine) are synthesized in the adrenal medulla. They affect the functioning of the cardiovascular system (change heart rate, increase blood pressure), stimulate the breakdown of fats, and increase blood glucose levels.

It is extremely important for the health of the entire body that the adrenal glands work correctly. Any violation of their function negatively affects the general condition of the patient.

The main causes of adrenal diseases:

• benign formations (adrenal adenomas), which produce certain hormones in excess;
• malfunction of the hypothalamic-pituitary system;
• autoimmune diseases;
• infections;
• tumors;
• uncontrolled use of certain medications.
• malignant neoplasms.

The structure and functioning of the adrenal glands

The adrenal glands are based on two structures:

• Brain matter.
• Cortical substance.

They are regulated by the nervous system.

Brain matter

The medulla is the main source of catecholamine hormones in the body - adrenaline and norepinephrine.

Adrenaline is the main hormone in the fight against stress. An increase in its production occurs during positive and negative emotions, for example, during injury or a stressful situation.

When exposed to adrenaline, the body uses reserves of accumulated hormone, which is manifested by the following reactions:

• a sudden surge of strength;
• increased breathing;
• pupil dilation.

The person feels stronger than usual, and the pain threshold is significantly reduced.

Norepinephrine is also a stress hormone, but its production occurs before the production of adrenaline. The impact is much weaker. Its function is to regulate blood pressure, which stimulates the work of the myocardium - the heart muscle.

Cortex

The adrenal cortex consists of several layers, each of which performs a specific function.

• Mesh zone.
• Bundle zone.
• Zona glomerulosa.

Androgens, sex hormones, are synthesized in the reticular zone. They are responsible for the development of secondary sexual characteristics and influence:

• state of libido - sexual desire in men and women;
• blood cholesterol and lipid levels;
• fat deposition;
• increase in muscle strength and mass.

Regardless of gender, each body produces both male and female sex hormones. The difference is in their quantity. For example, women synthesize estrogen and progesterone, which are responsible for reproductive function - conception and birth of children, but also testosterone in a small amount, which is considered the male hormone.

CIS or a fairy tale about the adrenal glands

Murzaeva Irina Yurievna

Endocrinologist, Preventive Medicine Doctor

March 19, 2017

I am beginning to cover one of the most complex topics in endocrinology – adrenal gland diseases. The adrenal glands are small, paired endocrine organs located, as the name suggests, above the upper pole of both kidneys. Length * width * thickness = 0.3 (0.7) * 0.2 (0.3) * 0.03 (0.1) cm. Even less than 1 cm in length and 3 mm in thickness is minimal. See picture.

This is such a small but extremely important organ and it’s impossible to simply talk about it. I really liked the form of presenting information in the form of a “fairy tale”. Now I’ll tell you another proverb about the adrenal glands. So... Deep in the abdominal cavity there is a CIS (adrenal friendly state) ;). Comparison with the well-known CIS is welcome.

States, and in our case, zones (layers) of the adrenal glands, exist side by side on the same territory. But each zone works autonomously, has its own leader (president), and different nationalities (hormones) live on the territory of each “state”. The adrenal glands are divided into 4 zones - states.

The adrenal cortex consists of 3 states: glomerular, zona fasciculata and zona reticularis. The adrenal medulla is located “in the inside” of the adrenal gland.

Glomerular "state".

Nationality: hormones produced by this zone: mineralocorticoids, represented by 3 hormones: Aldosterone, Corticosterone, Deoxycorticosterone.

This state does not have a leader; I would say it is the parliament. The production of mineralocorticoids is influenced by both potassium and angiotensin II, and some ACTH). The main work in this state: regulation of water-salt metabolism, exchange of electrolytes - potassium and sodium, maintaining salt homeostasis and blood pressure.

Hormone deficiency is chronic and acute adrenal insufficiency, pseudohypoaldosteronism. Excess – hyperaldosteronism syndrome (Conn syndrome, according to the author).

Bunch "state".

Nationality: glucocorticoids, represented by 2 hormones: Cortisol, Cortisone.

Leader: ACTH (adrenocorticotropic hormone), produced by the pituitary gland. Main job in the state: These hormones are responsible for the body's response to stress and survival. Regulate all metabolic processes in the body (carbohydrates, proteins and fats). Relieves inflammatory and allergic processes. Hormone deficiency is chronic and acute adrenal insufficiency.

Excess – Cushing's syndrome (hypercortisolism).

Grid State. Nationality: sex hormones. Presented: DHA (dihydroepiandrosterone), DHA-S (dihydroepiandrosterone sulfate), A4 (androstenedione), 17-OH progesterone, total testosterone. Head: ACTG. Main work: these sex hormones play a slightly different role than the hormones secreted by the sex glands. They are active before puberty (initiate puberty) and after puberty (especially DHA, which is a direct precursor to testosterone and estradiol). They also influence the development of secondary sexual characteristics (mustache growth, pubic and axillary hair growth, muscle mass, etc.)

Deficiency – adrenergic deficiency. Excess – adrenogenital syndrome, adrenal tumors.

Brain matter (state). Nationality: catecholamines are probably represented by the most famous adrenal hormones - adrenaline and norepinephrine, dopamine and their metabolites - metanephrine, normetanephrine. And also in small concentrations: substance P, VIP, somatostatin, beta-enkephalin.

Head (President): sympathetic nervous system. Main work: maintaining the vital functions of the body - stability of blood pressure, pulse, dilation of the bronchi, the work of other internal glands.

Deficiency is not possible (a condition incompatible with life)! Excess – pheochromocytoma.

That’s the end of the saying, and whoever has read it… moves on to the scientific part of the article :D.

Today we will talk about such a disease of the adrenal glands as adrenal insufficiency.

How often do patients come to an appointment with the main complaint - “no strength”, “loss of energy”, after work “like a squeezed lemon” and ask to check the function of the thyroid gland for hypothyroidism. So, the cause of this condition may be adrenal insufficiency. Adrenal insufficiency can be acute (AIF), I won’t write about it - it is a severe deficiency of cortisol, causes a condition incompatible with life, treatment occurs in the intensive care unit. Most often, acute insufficiency is a consequence of chronic adrenal insufficiency - chronic adrenal insufficiency, so we will learn how to identify it. There are primary CNN (due to damage to the adrenal gland itself by an inflammatory or tuberculous process) and secondary, when the central regulation of cortisol production suffers, that is, the secretion of ACTH is reduced (for one reason or another).

Symptoms of chronic adrenal insufficiency look like this:

• Weakness and loss of strength
• Decreased appetite with cravings for salty foods - only with primary CIU
• Nausea, vomiting, abdominal pain
• Weight loss (not always)
• Cycle disruption
• Depression
• Pressure drop below 90/55 N
• Swallowing disorder
• Irritability
• Changes in the shade of the skin and mucous membranes, an increase in pigmentation, like a pronounced bronze tan, only with primary congenital disorder.

Primary CNN differs from secondary in that with primary, the zona glomerulosa, where aldosterone is produced, also suffers (salt (sodium) begins to be lost from the body), resulting in cravings for salt and thirst. With secondary aldosterone zone does not suffer!!!! And during the primary, the skin tone changes brightly - such bronze pigmentation increases! This is due to the fact that ACTH and the hormone melatonin, which is responsible for pigmentation, are produced together; with primary congenital indigestion, ACTH begins to increase and melatonin along with it begins to increase. It turns out that, according to the clinical course, secondary CNN is easier than primary CNN.

Adrenal insufficiency may or may not be reversible. If it is reversible, it is relative adrenal insufficiency (failure of adaptation, reaction to stress), if it is not reversible, it is a disease and lifelong hormone replacement therapy with cortisol drugs is required.

How to Diagnose Adrenal Insufficiency:

1. Blood sampling for cortisol and ACTH at 8.00 am, when the production of this hormone is maximum (according to the circadian rhythm) or collection of saliva cortisol tubes at 4 points 8.00 - 13.00 - 17.00 - 24.00
2. Daily urine test for cortisol
3. Blood sampling for sodium, potassium, chlorine
4. Test with synacthen - depot
5. CT scan of the adrenal glands and/or MRI of the pituitary gland (if secondary CIU is suspected)
6. Phthisiatrician consultation
7. Blood test for 17-OH progesterone for suspected congenital adrenogenital syndrome
8. Aldosterone and renin for suspected primary CNN
9. 9HPLC of blood and urine (high performance liquid chromatography of adrenal hormones).

Taking blood for cortisol and ACTH is a complex procedure. It is complicated in that cortisol has a circadian rhythm of production - maximum in the morning and sharply minimum at night. So, in the morning, with the initial form of CHN, when cortisol is not yet so low, a diagnosis cannot be made with a single analysis, and at 23.00-24.00, when the cortisol concentration is minimal, the laboratories are not working. Since 2021, the medical laboratory and some other laboratories in the city have introduced into daily practice a very convenient method for determining cortisol in saliva at 4 points 8.00-13.00-17.00-24.00

(saliva is collected at home in test tubes taken the day before in the laboratory). This allows you to track all circadian fluctuations in daily cortisol, which is especially convenient when selecting hormone therapy in children. In addition, since 2021, we have introduced into practice in our center a test with synacthen-depot 1 mg (a long-acting artificial ACTH drug), which, unfortunately, is not produced in Russia. It allows you to exclude CNN with 100% probability. The test is minimal in complexity:

• at 8.00 a blood sample is taken for aldosterone and cortisol,
• at 21.00 synacthen is administered intramuscularly (which the patient can do at home),
• the next morning, aldostron and cortisol are measured again.

If cortisol rises to more than 550 nmol/l, CIU is excluded. The test allows you to differentiate primary and secondary CNN by increasing the level of aldosterone. If the initial blood cortisol in the morning is less than 80 nmol/l - further tests are not indicated - the diagnosis is clear. Based on the set of analyzes presented, a conclusion is drawn whether this is CNN as a disease or as a functional state (relative adrenal insufficiency), and a treatment tactic is selected. The functional state of the adrenal glands is never accompanied by a decrease in aldosterone! And it responds well to a test with synacthen. Sometimes a salivary cortisol test is enough to make a diagnosis, but only a doctor can decide this!!!! Treatment depends on whether it is primary or secondary CNN. Primary CIU is treated with both glucocorticoids and mineralocorticoids. Secondary CNN and relative CNN - only with glucocorticoids. Cortisol drugs are hydrocortisone, Cortef, prednisolone, methylprednisolone, dexamethasone. More often they choose a drug that is closer to natural: hydrocortisone or Cortef. Other drugs - in the absence of the first!

For the treatment of aldosterone deficiency - Cortinef, it has no analogues!

Doses are selected based on the clinical picture and restoration of levels of electrolytes, cortisol and renin. Treatment for chronic insufficiency is lifelong; discontinuation of therapy threatens acute adrenal insufficiency (AIF) and death!!! I would like to say a little not about the disease, but about relative adrenal insufficiency (functional) - it has become very common in the modern metropolis.

Reasons: lack of sleep, excessive mental stress and failure to adapt to stress, especially chronic stress, while persistently visiting the gym on an already weakened body, working in a state of acute respiratory viral infection or depression after parting with loved ones or depression for another reason, a sharp restriction of salt in the diet, supposedly for health benefits, lead to a gradual depletion of the zona fasciculata of the adrenal glands and a decrease in cortisol production, in the worst case, a mechanism for the production of antibodies to them or ACTH is triggered!!!! In the above cases, a diagnosis of cortisol deficiency by blood and salivary cortisol and blood sampling for ACTH and subsequent therapy with small doses of corticosteroids to normalize well-being are indicated. In addition, you need: good sleep at least 7 hours a day and taking good doses of vitamin C (to stimulate the production of your cortisol). One conclusion suggests itself - not only hypothyroidism can be the cause of complaints of weakness and weakness. And often, having not found an answer to his questions with normal thyroid function, the patient continues to visit doctors, even psychotherapists, in search of the reasons for his deteriorating health. In this case, do not forget to check the function of the adrenal glands.

To be continued ……

Beam zone

This zone is responsible for the synthesis of glucocorticosteroids. They are responsible for protein, carbohydrate and fat metabolism in the body. Closely related to the production of insulin and catecholamines.

Glucocorticosteroids reduce the immune response, inhibit inflammatory processes, gradually suppressing them.

One of the hormones in the zona fasciculata is cortisol. It takes part in carbohydrate metabolism and preserves the body's energy resources. The level of cortisol in the body is constantly changing - there is more of it in the morning than in the evening or at night.

Classification

Most adrenal adenomas are detected incidentally during ultrasound examination of the abdominal organs. Such tumors are called incidentalomas.

According to the type of morphological structure, adenomas are divided into:

• adrenocortical - are an encapsulated node that can be filled with serous fluid;
• pigmented - 2-3 cm in size, dark purple in color due to the pigmented cells present in the tumor;
• oncocytic - neoplasms of a granular structure, consisting of large cells containing mitochondria.

Adrenocortical adenomas are more common than others, pigmented adenomas are much less common. Oncocytic tumors are the rarest type.

Adrenal adenomas are hormonally inactive and hormonally active (hormone-producing). Types of hormone-producing adenomas:

• corticosteroma – produces corticosteroid hormones;
• aldosterome – produces aldosterone;
• androsteroma (virilizing adenoma) – stimulates increased production of androsterones (male sex hormones).

Zona glomerulosa

The zona glomerulosa of the adrenal cortex is responsible for mineral metabolism in the body. The hormones produced here normalize the functioning of the renal tubules, so excess fluid leaves the body, which, in turn, keeps blood pressure levels normal.

The following hormones are secreted in the zona glomerulosa:

• Aldosterone. Its function is to maintain the balance of sodium and potassium ions in the blood. The hormone takes part in water-salt metabolism, improves blood circulation, and increases blood pressure.
• Corticosterone is a hormone with low activity and is involved in mineral balance.
• Deoxycorticosterone also regulates water-salt balance, gives strength to the skeleton and muscle tissue.

Where are the adrenal glands located?

Paired endocrine glands (adrenal glands) are located in the space behind the peritoneum, above the right and left kidneys. It is noteworthy that the left adrenal gland has the shape of a hemisphere, the right one has the shape of a pyramid. These glands consist of 90% cortex, and 10% medulla. The adrenal medulla produces catecholamine hormones (adrenaline, dopamine, norepinephrine), and the cortex produces glucocorticoids, sex hormones, and mineralocorticoids. Diseases of the adrenal glands can cause excess, deficiency, or no hormonal function.

How do adrenal gland diseases manifest?

When the balance of hormones in the body is disturbed, its functioning occurs. Symptoms appear according to a dependence pattern, that is, a specific substance produced in the adrenal glands is responsible for a symptom unique to it. For example, with aldosterone deficiency, sodium is excreted from the body along with the urine, which lowers blood pressure and significantly increases the potassium content in the blood.

To avoid serious consequences, you need to consult a doctor at the first signs of adrenal disease. These include:

• muscle weakness;
• constant fatigue;
• severe weight loss is a consequence of decreased appetite;
• low stress resistance;
• high irritability;
• rapid and constant fatigue;
• sleep problems;
• dizziness, headaches.

Next, the most common diseases of the adrenal glands, which have their own symptoms and causes, require specific treatment tactics.

Incidentally discovered tumors

With the introduction of ultrasound examination and high-resolution radiological methods of topical diagnostics, such as computed tomography and magnetic resonance imaging, into medical practice, formations in the adrenal glands began to be detected in patients examined for various reasons, which had not previously manifested themselves clinically. In most cases, we are talking about relatively small neoplasms ranging in size from 0.5 to 6 cm in diameter. These tumors became known as incidentalomas. The incidental discovery of an adrenal tumor should prompt the physician to more carefully examine the patient for symptoms of adrenocortical, adrenomedullary disease, or malignancy. Tactics regarding adrenal incidentaloma depend, firstly, on whether it is a source of excess production of any hormone, and, secondly, whether it is a malignant tumor. Hypersecretory formations of the adrenal glands require specific therapy and, most often, surgical intervention. In general, the approach to adrenal incidentalomas is such that hypersecretory and malignant formations require removal, as well as tumors of large sizes (more than 5 cm) and suspicious for malignancy, while formations that have been proven to be benign, such as a simple adrenal cyst, myelolipoma and Adrenal hematoma requires only regular (every six months) CT monitoring.

Addison's disease

Other names for Addison's disease are primary adrenal insufficiency and hypocortisolism.

A rare pathology, accounting for 50–100 cases per million per year. It is diagnosed in both women and men. Average age is from 20 to 40 years.

The disease affects all three zones of the adrenal cortex. Characterized by a deficiency in the production of corticosteroids. Violation of hormone synthesis causes serious complications in the body.

The cause of destruction of the adrenal cortex is pathogenic microorganisms that have entered the body - viruses, bacteria, fungi, as well as immune disorders.

Manifestations of Addison's disease:

• decreased blood pressure;
• fatigue, weakness, lack of physical strength;
• lack of appetite;
• disruption of the digestive system;
• pigmentation of the skin, the appearance of dark spots on the mucous membranes;
• chills;
• increase in body temperature.

To identify the disease, it is necessary to take tests to measure the level of cortisol in the blood. The condition of the adrenal cortex and the functioning of the glands are examined.

Treatment is taking medications containing corticosteroids throughout life. It is possible to administer hydrocortisone intramuscularly.

... and a man into a woman

Corticoestroma is a hormonally active tumor of the adrenal cortex, emanating from the zona reticularis and zona fasciculata, excessively producing estrogens, and in some cases, glucocorticoids. Corticoestromas are most often malignant with pronounced expansive growth. Clinically, corticoestroma is characterized in males by the appearance of bilateral gynecomastia, redistribution of fatty tissue and female-type hair growth, testicular hypotrophy, increased timbre of voice, decreased potency up to its loss. Oligospermia is often observed. Some patients experience pigmentation of the areolas of the mammary glands and even discharge from the nipples when pressing on them. In boys, signs of the disease include gynecomastia and premature bone maturation. A feminizing tumor of the adrenal cortex in girls is accompanied by a clinical picture of premature puberty: enlargement of the mammary glands and external genitalia, pubic hair growth, accelerated body growth, premature skeletal maturation, vaginal bleeding. In women, this tumor does not manifest itself in any way and can only be accompanied by an increase in the level of estrogen in the blood. Adrenal tumors that manifest only pure feminization are extremely rare. Treatment is only surgical (removal of the tumor along with the affected adrenal gland). To prevent possible adrenal insufficiency in the postoperative period, glucocorticoid replacement therapy is prescribed.

Itsenko-Cushing's disease

Refers to neuroendocrine pathologies. The reason is a malfunction of the hypothalamic-pituitary system as a result of brain injury or infections suffered by a person. Characterized by the production of excessive amounts of corticosteroids by the adrenal glands.

Itsenko-Cushing's disease is a rare pathology. It is diagnosed mainly in women aged 30 to 45 years.

A malfunction in the hypothalamic-pituitary system provokes disturbances in the body. The connection between the adrenal glands, hypothalamus and pituitary gland is lost. Signals sent to the hypothalamus provoke excess production of hormones that release adrenocorticotropic hormone (ACTH) in the pituitary gland, which stimulates the release of the substance into the blood. Excessive amounts of ACTH affect the adrenal glands, which begin to increase the production of a lot of corticosteroids.

As the pathology progresses, there is a visible increase in size of the pituitary gland and adrenal glands.

Signs of Itsenko-Cushing's disease:

• headaches, migraines;
• progressive hypertension;
• amyotrophy;
• formation of a moon-shaped face;
• lack of menstruation in women;
• development of osteoporosis;
• facial hair growth in women.

To identify the disease, blood and urine tests are prescribed, which determine excess amounts of ACTH and cortisol. Additionally, an instrumental examination is carried out.

The goal of therapy is to restore impaired metabolism, normalize the functioning of the hypothalamus, and normalize the synthesis of corticosteroids.

Causes of adrenal gland diseases

Pathologies in the functioning of the adrenal glands can be caused by the following factors:

• excessive production of the hormone (ACTH);
• ACTH hormone deficiency;
• excessive production of hormones by the adrenal glands themselves;
• insufficient production of hormones in the adrenal glands themselves;
• brain dysfunction;
• the presence of tumors in the adrenal gland;
• congenital pathology;
• inflammatory and infectious processes (including chronic);
• circulatory disorders in the adrenal gland.

Treatment of the disease depends on where exactly the pathological process began. An endocrinologist determines the clinical picture for each patient, which is necessary to determine the cause of the ailment. But full treatment is prescribed only after completing a diagnostic course and collecting all the information about the patient.

The first meeting with an endocrinologist is an opportunity for the patient to voice the problem as fully as possible (complaints, symptoms, causes, etc.) and an opportunity for the doctor to collect all the necessary information (history, examination, measurement of height, weight, blood pressure, background hormonal tests). research and functional tests).

Diagnostics includes:

• Ultrasound of the adrenal glands (screening method);
• general clinical tests;
• blood and urine analysis for hormone levels and all necessary hormonal studies;
• CT scan;
• consultations with a gynecologist, urologist.

Repeated appointment

At a follow-up appointment, the doctor draws up a treatment plan based on the results of diagnosing adrenal disease and the patient’s individual symptoms of the disease.

The course of treatment may include one or more methods:

• conservative treatment;
• hormone replacement therapy (prescribing a synthetic hormone to replace what is not produced by the adrenal glands);
• surgery.

As a rule, treatment is aimed at eliminating hormonal imbalance (if necessary, surgical removal of the affected adrenal gland is carried out) and other signs of adrenal disease. It is also possible to prescribe special programs for weight loss and normalize blood pressure, and regular visits to a psychotherapist’s office are also possible.

Pheochromocytoma

Pheochromocytoma is a tumor that develops in the adrenal medulla. It is based on chromaffin bodies, which contribute to the synthesis of large amounts of catecholamines.

The cause is arterial hypertension and catecholamine crises.

Symptoms of pheochromocytoma:

• high blood pressure, hypertensive crises;
• headache;
• increased sweating;
• dyspnea;
• dehydration of the body;
• convulsions;
• cardiomyopathy;
• high blood sugar.

To diagnose the disease, tests are prescribed to determine catecholamine metabolites in the urine and blood. To identify the formation, hardware methods are used - MRI and ultrasound scanning.

Treatment is medicinal, aimed at reducing the severity of paroxysmal attacks.

Diagnostics

The main methods for diagnosing adrenal diseases are:

General blood analysis. Provides general information about the patient's health and condition.

Blood chemistry. The most important thing here is to study the level of blood electrolytes (potassium, sodium), as well as assess the function of the kidneys and liver.

1. Blood test for hormones. The main laboratory method for identifying pathologies of the adrenal glands.
2. Daily urine analysis. It is carried out to assess the functioning of the adrenal glands.
3. Computed tomography (CT). Today it is the gold standard for diagnosing adrenal tumors.
4. Ultrasound of the adrenal glands and kidneys. Currently, it is not used so often, since it is not always possible to visualize the adrenal glands on ultrasound.
5. Radiography. Today it is practically not used for the study of the adrenal glands. Instead of radiography, CT is performed, since this method is more informative.

Hyperaldosteronism

Another name for the pathology is Kohn syndrome. A condition in which the adrenal cortex produces excessive amounts of aldosterone and deoxycorticosterone.

The causes of hyperaldosteronism are a malignant formation in the adrenal cortex or hyperplasia of cortical tissue.

Kohn syndrome has primary and secondary degrees of development. Symptoms of the primary degree of the disease:

• increased blood pressure;
• headache;
• heart rhythm disturbance;
• cardialgia – pain in the left side of the chest;
• decreased visual acuity.

Secondary symptoms result from excess potassium and sodium deficiency:

• swelling;
• chronic renal failure;
• fundus deformation;
• arterial hypertension.

Diagnostic measures include determining the level of potassium and sodium, aldosterone in the blood and urine.

Therapy depends on the results of the examination. More often this is drug treatment with the prescription of hormonal drugs. If a tumor is present, surgery may be performed.

Why do “flies” fly before my eyes?

Clinical manifestations of primary hyperaldosteronism (PHA): arterial hypertension (headache, dizziness, appearance of “floaters” before the eyes); disorders of neuromuscular conduction and excitability (muscle weakness, parasthesia, convulsions, bradycardia); changes in renal function (polyuria, polydipsia, nocturia). These signs are not always present simultaneously; An oligosymptomatic and even asymptomatic course of the disease is often observed. Approximately two-thirds of all cases of PHA are caused by aldosteroma. Another possible cause of PHA is nonadenomatous bilateral adrenal hyperplasia, which occurs in one third of patients with symptoms of idiopathic primary hyperaldosteronism. The main treatment method for aldosteroma and nodular adrenal hyperplasia is surgery - removal of the altered adrenal gland along with the tumor (adrenalectomy). Performing organ-saving operations (tumor enucleation, adrenal resection) by most surgeons operating on endocrine organs is considered inappropriate due to the high rate of relapse of tumors in the remaining tissue (up to 50%). Already in the immediate postoperative period, in most cases, normalization of blood pressure, a decrease in the concentration of aldosterone in plasma, a gradual increase in renin activity, and normalization of potassium are noted.

Hyperplasia of the adrenal cortex

This is an increase in the size of the adrenal cortex, which leads to increased synthesis of androgens. The main reason is genetic, that is, the disease is congenital.

There are three main forms of hyperplasia:

• Simple virilizing. There is an increase in the synthesis of androgens, as a result of which the genitals and muscle tissue become enlarged, and hair grows rapidly all over the body, regardless of the gender of the sick person.
• With salt loss syndrome. Characterized by excess potassium and deficiency of other hormones.
• Hypertensive. Excessive production of androgens and corticosteroids occurs, as a result of which arterial hypertension develops and visual function deteriorates.

Symptoms of adrenal hyperplasia:

• early hair growth on the body and genitals;
• growth is less than normal;
• rough voice;
• memory problems;
• frequent psychoses;
• weakness of the muscular system.

Signs appear in childhood. To clarify the diagnosis, tests and laboratory tests are prescribed.

Treatment is medicinal and includes constant use of hormonal drugs. In severe cases of the disease, surgical intervention is indicated.

Extra pounds, hump and stretch marks...

The main and only treatment method for hypercortisolism caused by a tumor of the adrenal cortex or nodular hyperplasia of the adrenal cortex (Cushing syndrome) remains removal of the affected adrenal gland with the tumor. The clinical picture of hypercortisolism is very specific, therefore, in a significant proportion of patients, nosological diagnosis does not present any great difficulties. obesity, a “hump” on the back of the neck, wide purple “striae”, arterial hypertension, impaired carbohydrate metabolism and sexual function, osteoporosis and hypokalemia allow us to suspect overproduction of cortisol by the adrenal glands. At the next stage of diagnosis, especially in the absence of clear external clinical signs, the most important, and sometimes decisive, importance is the assessment of laboratory hormonal parameters. Ultrasound examination of the adrenal glands has relatively high sensitivity, it is non-invasive, relatively harmless, and accessible. The sensitivity of the ultrasound method in detecting adrenal tumors depends on their size and averages 50-90%. Corticosteroma is detected as a round formation of various sizes, with an indistinct capsule. Acoustic density appears to be slightly reduced compared to normal adrenal gland. CT is highly effective in diagnosing diseases of the adrenal glands. For adrenal adenomas, the sensitivity of the method reaches 98%. With benign corticosteromas, the prognosis is favorable. Already in the first 1.5-2 months after tumor removal, a gradual regression of clinical symptoms is noted: the patient’s appearance changes, metabolic processes are normalized, blood pressure decreases to normal, stretch marks and the face turn pale, sexual function is restored; diabetes mellitus observed before surgery disappears. In the first months after surgery, patients' body weight decreases significantly (sometimes by more than 20 kg); hirsutism usually disappears after 3-8 months. X-ray signs of bone tissue restoration are recorded after 10-12 months, but bone pain disappears within 1-2 months after surgery.

Adrenal insufficiency

This is a dysfunction of the adrenal glands of an autoimmune nature. There are two types - acute and chronic.

Chronic insufficiency of the adrenal cortex occurs as a result of destructive changes in the glandular tissues of the organ. The main causes are previous infectious diseases, a pituitary tumor or macroadenoma, necrosis or inhibition of the anterior lobe of the pituitary gland.

The acute form develops against the background of the chronic form. It almost never occurs on its own, with the exception of sepsis or sudden hemorrhage in the adrenal glands.

Symptoms of adrenal insufficiency:

• weakness, constant loss of strength;
• loss of appetite, resulting in a sharp decrease in body weight;
• hyperpigmentation of the skin;
• arterial hypotension;
• decreased blood sugar levels;
• frequent urination;
• nausea turning into vomiting;
• uncharacteristic stool.

Causes of adrenal dysfunction

The main reason for changes in the functioning of the adrenal glands is stress. If the stressful situation is short-term, the paired organ works normally. Prolonged emotional overload and nervous tension cause exhaustion of the adrenal glands. At the initial stage, a person experiences chronic fatigue.

Provoking factors are also a lack of minerals, vitamins, fats and proteins. Impairment of the organ's functioning is facilitated by taking oral contraceptives. Past infectious diseases have a negative impact.

The reason to check your hormone levels is constant lethargy and fatigue, especially at a young age.
Causes of concern include excessive irritability, breakdowns, and headaches. Products containing magnesium, potassium, and zinc help improve the functioning of the paired organ. vitamin C, B. It is necessary to eat Omega-3 fatty acids, vegetables, seeds, avocados, nuts, herbs, poultry and fish. It is important to reconsider your lifestyle, avoid nervous tension and prolonged stress.

Inflammation of the adrenal glands

Inflammatory processes in the adrenal glands most often occur against the background of tuberculous damage to their cortex. The peculiarity of the pathology is its slow development.

Characteristic symptoms of inflammation:

• feeling of constant fatigue;
• low stress resistance;
• regular nagging headaches;
• bad breath;
• nausea turning into vomiting.

With an advanced form, there is a high probability of developing a chronic inflammatory process.

Cortisol

Cortisol, or compound F, is produced by the zona fasciculata of the adrenal cortex. Its synthesis is a chain of transformations from cholesterol to pregnenolone, then to progesterone, corticosterone, which develops into cortisol.

Cortisol is an active participant in protein, lipid, and carbohydrate metabolism. It forms glycogen reserves in the liver - “energy in reserve”, affects the synthesis of cellular enzymes, water-salt balance. Almost every cell has receptors for cortisol, so its effect on the body is extensive and pronounced.

Cortisol is called the stress hormone because it forms a protective response to external threats and is responsible for:

• increased blood pressure;
• increased heart rate;
• vascular tone;
• muscle function (reduces glucose consumption in muscles and borrows it from other organs).

All these reactions are aimed at physical work - running, wrestling and the like, i.e. they remained at the level of ancient man. However, modern people cannot escape stress by running away, because glucose accumulates in the muscles, which threatens the development of diabetes. At the same time, the organs that gave up glucose “starve” - and the person begins to eat more sweets and starchy foods, which leads to obesity.

Cortisol lowers the number of white blood cells in the blood. This leads to a weakened immune response, which is good for allergic reactions, but bad for wound healing and inflammatory processes.

Scientists have identified a connection between the level of the hormone and a whole group of unstable mental conditions, for example, depression and anxiety. High levels of the hormone over a long period of time lead to the extinction of sexual desire, and in women, to disruption of menstruation and even its complete cessation.

Reasons for abnormal cortisol levels

A decrease or increase in cortisol levels can be caused by many reasons. Thus, a low level is the cause of problems with the pituitary gland or the adrenal glands themselves, the thyroid gland, with hepatitis and cirrhosis of the liver.

High levels can be caused by tumors that produce adrenocorticotropic hormone, pathologies of the thyroid gland, certain types of medications, and cirrhosis of the liver. An increase in level occurs with depression and uncompensated diabetes mellitus.

Consequences, symptoms of persistently elevated, high levels of cortisol:

• central obesity with thin arms and legs;
• thin skin with a tendency to bruises;
• muscle weakness, especially in the shoulders and hips;
• high blood pressure;
• diabetes mellitus or glucose intolerance;
• reddened, rounded face;
• unmotivated or poorly motivated mood swings;
• increased thirst and frequent urination.

Consequences, symptoms of low, low cortisol levels (increase gradually):

• fatigue and dizziness;
• weight loss;
• muscle weakness;
• change in color in certain areas of the skin (darkening).

Important!

Low cortisol levels (Addison's disease) are potentially life-threatening and require urgent examination by an endocrinologist.

Normal cortisol level in a calm state, deviations:

• in the morning - 101.2–535.7 nmol/l;
• in the evening - 79.0–477.8 nmol/l;
• in pregnant women in the 3rd trimester - 2-5 times higher than the usual norm;
• in stressful and critical situations - up to 10 times higher than normal.

How to submit biomaterial and prepare for research

The hormone level is determined by a general/biochemical blood test and urine test. You need to donate blood for cortisol testing in the morning (before 10 o’clock), on an empty stomach - the last meal should take place 8 or more hours before blood sampling. On the day before donating blood, you should avoid psycho-emotional, physical stress, and drinking alcohol.

The reliability of the diagnosis requires several tests to exclude random increases/decreases caused by external factors. If the hormone level is potentially high, blood is also donated in the evening, after 17:00, following the same recommendations as in the morning.

A urine test for cortisol levels is usually done to diagnose adrenal function. For research, take up to 120 ml of volume collected during the day.

The result of the blood test is provided after 24 hours, if urgently necessary - after 2-3 hours; urine tests - after 3-5 days. The speed of research depends on the workload and equipment of the laboratory. The accuracy of the results is high.

Adrenal tuberculosis

Adrenal tuberculosis is a rare pathology. It is characterized by the accumulation of calcifications in the tissues of the adrenal glands.

More often diagnosed in childhood and adolescence. The reason is the penetration of the tuberculosis bacillus from the infected lungs into the adrenal glands through the general bloodstream.

Symptoms of adrenal tuberculosis:

• low blood pressure;
• disruption of the gastrointestinal tract, expressed by diarrhea, nausea with vomiting attacks;
• hypoglycemia;
• constant weakness, feeling tired;
• myocardial dystrophy.

Symptoms of the disease

Typically, adrenal adenomas are discovered by chance, are small in size, develop asymptomatically, and do not affect hormone production.

Symptoms of large hormonally inactive tumors (over 10 cm) are a consequence of their compression of surrounding tissues and organs. For example, if an adenoma compresses the inferior vena cava, blood flow in the lower half of the body is disrupted, and swelling appears. Neoplasms of this size are extremely rare.

The symptoms of hormone-producing tumors depend on the hormones they produce.

Corticosteroma

It is characterized by hypercortisolism - excessive secretion of the corticosteroid hormone cortisol. Patients, most often women 20-40 years old, suffer from Itsenko-Cushing syndrome, which has three characteristic signs:

• Cushingoid obesity with fat deposits on the face, neck, chest and abdomen;
• atrophy of the muscle layer in the shoulder girdle, legs and buttocks;
• thinning of the subcutaneous fat and skin on the back of the hands, stretch marks - stretch marks of purplish-red or purple color on the skin of the abdomen, chest, inner surface of the shoulders and thighs.

Hypercortisolism is characterized by neuropsychic disorders - depression, lethargy, psychotic reactions. Osteoporosis often develops - a decrease in bone density due to the leaching of mineral salts. In 10-20% of cases, secondary diabetes mellitus (steroid-induced) is detected.

In women, an adrenal adenoma that secretes cortisol leads to hirsutism - excessive hair growth of the skin, and menstrual irregularities - amenorrhea or dysmenorrhea.

Aldosteroma

This tumor is characterized by increased production of aldosterone, a hormone that regulates sodium-potassium metabolism. Its excess provokes primary hyperaldosteronism (PHA), or Conn's syndrome. Sodium and fluid are retained in the patient's body, the volume of circulating blood increases, and blood pressure rises. Potassium, on the contrary, is excreted by the kidneys, which causes muscle weakness and cramps. Other signs of PHA are frequent urination, including at night, and thirst.

Androsteroma

It produces male sex hormones, so its manifestations are different for men and women.

In women, androsteroma causes symptoms of virilization. These include:

• development of muscles according to the male type;
• hypoplasia of the mammary glands;
• clitoral hyperplasia;
• excess hair on the face and body;
• dysmenorrhea or amenorrhea;
• deepening of the voice.

Symptoms of androsteroma in men are less noticeable, so such adrenal adenoma is diagnosed quite late in them.

Cyst

This is a benign formation in the tissues of the adrenal glands. The tumor appears rarely and becomes dangerous only when it degenerates into malignant. A dangerous condition is when an adrenal cyst ruptures.

Tumor symptoms:

• pain in the lower back, back, sides;
• impaired renal function;
• an increase in the size of the adrenal glands;
• increased blood pressure as a result of compression of the renal artery.

Diagnosis of an adrenal cyst is difficult due to its small size. Pathology can only be detected when the tumor progresses and grows.

Salvage adrenalectomy

In 2002, it was 10 years since Michel Gagner first described the experience of successful laparoscopic adrenalectomies in periodicals. In one decade, this minimally invasive surgical technique has rapidly spread throughout the world, developing and improving. Currently, due to its safety and practicality, endoscopic adrenalectomy has become firmly established in the arsenal of adrenal surgery. During the period from November 1996 to May 2004, we performed 152 endoscopic operations in patients with adrenal pathology. Over the past few years, we have preferred extraperitoneal (“posterior”) adrenalectomies, which are more difficult to perform for the surgeon, but much easier to tolerate by the patient. We have extensive experience in these operations. Most of our patients are discharged from the clinic 3-4 days after surgery, and after 2-3 weeks they are allowed full physical activity, which is impossible with “open” operations. Add to this the absence of a large scar, possible weakening of the muscles of the lumbar region in the postoperative period, and the advantages of endoscopic adrenalectomy will become undeniable. After one of the adrenal glands is removed, the second one takes on the entire load. In this case, the patient usually requires lifelong hormone replacement therapy, which should be prescribed by an endocrinologist. In the future, it is necessary to undergo a follow-up examination every six months and consult with a doctor, who will adjust the therapy depending on the test results and the patient’s health condition. Patients who have undergone adrenalectomy also need to avoid physical and mental stress, and not drink alcohol or sleeping pills.

Dangerous tumors

If the cyst is a benign formation, then there are a number of tumors prone to malignancy.

The most common of them:

• aldosteroma;
• andosteroma;
• glucocorticosteroma;
• corticoestroma.

The exact reasons for the development of formations are difficult to establish, but there is a high probability of their hormonal activity against the background of the following provoking factors:

• cell hyperplasia and proliferation of adrenal tissue;
• excessive amounts of hormones produced;
• thyroid cancer;
• diseases associated with congenital pathologies of the skin, eye membrane, and cerebral vessels.

The localization of tumors varies. They can form in both the medulla and cortical layers. Characteristic symptoms:

• high blood pressure;
• delay in the process of sexual development;
• frequent nausea, turning into vomiting;
• pain in the abdomen, chest area;
• change in skin color on the face - turns pale, red, acquires a bluish tint;
• a sharp change in blood glucose levels;
• dry mouth;
• convulsions;
• tremor of the limbs;
• increased irritability, excitability;
• increased anxiety, constant feeling of fear.

"Crisis" tumor

Pheochromocytoma is a tumor of chromaffin cells that produces excess amounts of catecholamines (adrenaline, norepinephrine and dopamine). Pheochromocytoma may develop from chromaffin tissue of the adrenal medulla (90%) and may be non-adrenal in location. The disease occurs at any age. The main symptoms of the disease in the vast majority of patients are arterial hypertension, hypermetabolism and hyperglycemia. The classic clinical picture is considered to be periodic rises in blood pressure, accompanied by some vegetative symptoms, reminiscent of the effects of the administration of adrenaline or norepinephrine. In the initial period of the disease, these attacks, or crises, occur rarely - once every few months or even years. Over time, the frequency, duration, and severity of attacks usually increase. The onset of a crisis is quite often characterized by the appearance of unaccountable fear, sometimes a feeling of chilliness, paresthesia, marbling or pallor of the skin. Sometimes, on the contrary, there is pronounced redness of the facial skin, shiny eyes, dilated pupils, and frequent urge to urinate. A crisis can begin with paresthesia, convulsions, and vasoconstriction of the extremities. The crisis ends as suddenly and quickly as it began. Blood pressure returns to its original values, the pallor of the skin gives way to redness, and sometimes profuse sweating and excessive secretion of the salivary glands are observed. After an attack, general weakness and weakness persist for a long time. The diagnosis of pheochromocytoma is established when elevated amounts of catecholamines or their metabolites are detected in 24-hour urine. The most reliable is urine analysis collected within 3 hours after the attack. The accuracy of the method reaches 95%. It is recommended to conduct such studies several times. Tumor detection is usually carried out using ultrasound, CT and MRI. If the diameter of the tumor is more than 10 mm, then the sensitivity of these methods approaches 100%. Ultrasound is important in establishing the location of pheochromocytoma. However, its effectiveness largely depends on the experience of the specialist; Moreover, for tumors of extra-adrenal localization, the method is not very informative. Treatment of tumors that produce catecholamines is only surgical. However, surgical interventions for pheochromocytoma are classified as very complex, primarily due to the high degree of surgical risk associated with the likelihood of severe hemodynamic disturbances. In this regard, the cooperation of the surgeon and anesthesiologist and the choice of the most rational method of preoperative preparation and anesthesiological care are of particular importance. During preoperative preparation, the main attention should be paid to the prevention and relief of hypertensive crises. After surgery, hormone replacement therapy is often prescribed - a constant intake of adrenal hormones.

Where to get tested

The network of medical centers and laboratory terminals of SZTsDM JSC covers St. Petersburg, Novgorod, the Leningrad region, Kaliningrad, Pskov.

To find the branch closest to you, use the drop-down menu on the top bar, interactive map or table. In the menu and on the map, you can click on the selected object - and you will receive complete information about the location, hours and days of reception. The map can be opened in YandexMaps to conveniently calculate the route.

In any department you will be greeted by qualified and attentive staff, sterile cleanliness, and you will be provided with a modern level of service and diagnostics.

We invite you to undergo research on the level of adrenal hormones at SZTSDM!

Remember that early detection of a problem is the key to complete and rapid success in identifying it. Be healthy!

Aldosterone

Aldosterone is a steroid hormone. Its main function is to regulate salt and water levels in the body, whose levels directly affect blood pressure.

The hormone acts on the kidneys and colon, increasing the amount of sodium reabsorbed into the bloodstream and sodium excreted in the urine. Aldosterone causes the reabsorption (reabsorption) of water along with sodium, which increases blood volume and with it blood pressure.

Aldosterone is part of the renin-angiotensin-aldosterone group of related hormones. The system is activated if blood flow to the kidneys decreases. Aldosterone increases the reabsorption of salt and water from the kidneys into the bloodstream, thereby increasing blood volume, restoring salt levels and blood pressure.

Reasons for changes in aldosterone levels

The most common cause of high hormone levels is overproduction caused by primary hyperaldosteronism (Conn's syndrome). The syndrome develops against the background of diffuse edema, adrenal hyperplasia or a small, always benign tumor in the gland (adrenal adenoma). Sometimes hyperaldosteronism is a hereditary disease.

Consequences, symptoms of elevated aldosterone levels:

• an increase in blood volume above normal;
• low level of potassium in the blood (about 1/3 of subjects with hyperaldosteronism);
• high blood pressure - in this case it does not respond to several drugs to regulate blood pressure;
• in some cases - convulsions, severe thirst, weakness.

Consequences, symptoms of low aldosterone levels:

• decreased blood pressure;
• lethargy;
• increased potassium levels in the blood.

Aldosterone levels for people over 15 years of age (not established for children and adolescents):

• 22.1 – 353 pg/ml in a vertical position;
• 2.8 – 39.9 µIU/ml in a horizontal position;
• less than 12 pg/μIU—aldosterone-renin ratio (ARR).

The Russian Association of Endocrinologists recommends diagnosing primary hyperaldosteronism when APC ≥ 50; in international practice - with APC ≥ 30.

To confirm the diagnosis, a repeat study is required, since there are many factors that lead to false positive and false negative results. Among them are hyperkalemia, drug effects, renal failure, hypokalemia, pregnancy and others.

How to submit biomaterial and prepare for research

Approximately 2 weeks to a month before the study, you need to adhere to a low-carbohydrate diet, do not take diuretics, antihypertensive drugs (after consultation with a doctor), oral contraceptives, steroid drugs, estrogens.

A week before the study, stop taking renin inhibitors. In 3 days, physical and psycho-emotional stress is eliminated. And 3 hours before donating blood you need to refrain from smoking.