It’s January 20, 1961. You flip on your brand new black and white TV to watch the inauguration of the 35th president of the United States, the youngest president ever elected. The picture is fuzzy, but his words ring through clear: “Ask not what your country can do for you, ask what you can do for your country.” Those words inspire a generation of Americans to literally shoot for the moon.
What the country didn’t know, though, was that their president, John F Kennedy, had Addison’s Disease, also known as adrenal insufficiency.
What are the adrenals and what do they do?
To understand adrenal insufficiency, it’s helpful to start off with some anatomy. The adrenals are small, pyramid-shaped glands that reside on top of the kidneys. Just like the kidneys, there are two adrenals—one on each side.
Their function is to produce cortisol, aldosterone, epinephrine (adrenaline) & norepinephrine, and androgenic hormones & DHEA.
What do the adrenal hormones do?
- Cortisol – Many people are familiar with cortisol as the “stress hormone.” Our adrenals release cortisol in times of stress to help our bodies react to emergency situations and heal from injury. In addition, cortisol plays a role in regulating metabolism, blood pressure, blood sugar, and your sleep-wake cycle. Cortisol release can also affect your immune system.
- Aldosterone – This hormone is important for keeping your electrolytes balanced and regulating blood pressure.
- Epinephrine (adrenaline) and norepinephrine – These are the “fight-or-flight” hormones. In response to stress, these hormones make your heart pound, your blood flow faster, and get your muscles ready for action.
- Androgenic hormones and DHEA – These hormones are also known as steroid hormones. Androgenic hormones are precursors to the more commonly known testosterone and estrogen, the hormones which give us male and female characteristics.
What is adrenal insufficiency?
Adrenal insufficiency occurs when your adrenal glands don’t make enough of the hormones they’re supposed to make. This can happen for one of three reasons.
First is simply that the adrenal glands are not working properly. This can be due to tuberculosis, but these days most cases are caused by an auto-immune condition (in which the body is attacked by its own immune system). This type of adrenal insufficiency is called primary adrenal insufficiency, or Addison’s Disease, and is the disease that President Kennedy had.
The second cause of adrenal insufficiency comes about because the adrenals are not being told to make enough hormone. It is the job of a little gland in your brain called the pituitary gland to tell the adrenals when to produce hormone. If the pituitary doesn’t release a hormone called adrenocorticotropic hormone (ACTH), then the adrenals don’t go to work. This is called secondary adrenal insufficiency.
That brings us to the third cause, tertiary adrenal insufficiency. Tertiary adrenal insufficiency happens when the pituitary is not told by the hypothalamus (an area in your brain just above the pituitary) to make ACTH, the hormone that tells the adrenal glands when to kick into gear.
What are the symptoms of adrenal insufficiency?
Symptoms of adrenal insufficiency are non-specific and varied. They include:
- Weight loss
- Muscle weakness
- Decreased appetite
- Low blood pressure
- Low blood sugar
- Abdominal pain, nausea/vomiting
- Skin darkening (think JFK’s ever-present tan)
- Women can experience irregular or absent menstrual cycles
What is the treatment?
Treatment for adrenal insufficiency is aimed at replacing the hormones that aren’t being produced in the adrenal glands. You may be given corticosteroids like hydrocortisone, prednisone, or methylprednisolone to make up for the lack of cortisol. Similarly, you may be given fludrocortisone to replace the missing aldosterone. These medications can be taken orally.
What is an acute adrenal crisis?
Anyone with adrenal insufficiency can experience a life-threatening acute adrenal crisis. Symptoms include:
- Rapid heartbeat
- Loss of consciousness
An acute adrenal crisis must be treated immediately with an injection of corticosteroids. For this reason, it is recommended that you carry a glucocorticoid injection kit with you.
How will adrenal insufficiency affect my pregnancy?
About half of those affected by adrenal insufficiency are women. However, adrenal insufficiency in pregnancy is rare. This can be due to many reasons. One reason is that the reduced amounts of androgenic hormones produced in the adrenals may make it more difficult to conceive.
If you are pregnant, your metabolic demands change and an increased burden is placed on your adrenal glands. If you have adrenal insufficiency, your doctor will carefully manage your condition both during and after your pregnancy by adjusting your medication dosage.
Some symptoms of adrenal insufficiency can be mistaken for normal pregnancy symptoms (increased fatigue, nausea and vomiting). Because of this it is very important you pay close attention to your symptoms. It’s also important to note that pregnancy can put you at increased risk for an acute adrenal crisis.
What happens when I go into labor?
When you go into labor, you will most likely be placed on a glucocorticoid drip to help manage your body’s need for increased cortisol. After you deliver your baby, your medication dosage will likely be increased for a few days to help your body through the stress of healing. Your doctor with adjust your medication back to your pre-pregnancy dosage in the days that follow.
If you have adrenal insufficiency and are pregnant, it’s important to seek medical care and advice from a physician. With proper management you can have a safe and healthy pregnancy.