THE ADRENAL GLANDS
The adrenal glands produce the hormone cortisone, which controls the amount of fluid and salt in the body and helps the body respond to stress. The correct amount of cortisone is important for your well-being. Some illnesses affecting older people can lead to a decrease in the spontaneous production of cortisone. However, most cases of insufficient natural cortisone occur because a cortisone medication has been prescribed for an illness such as asthma, arthritis, or certain skin conditions, which suppresses the body’s production of cortisone.
Some people spontaneously produce excess amounts of cortisone, which leads to Cushing’s disease. The cortisone accumulates and adversely affects many parts of the body. This is due to tumors of the adrenal gland or excessive stimulation of the adrenal glands by pituitary gland hormones. You may become overweight and develop high blood pressure or diabetes mellitus. Your bones may weaken and be prone to fractures, and your skin may develop small hemorrhages under the surface at the slightest touch. You may begin to feel generally weak and ill.
The diagnosis of Cushing’s disease is made by special blood tests. Treatment may consist of surgical removal of one or both adrenal glands. In many cases radiation to the pituitary gland can be effective in halting the disease. The pituitary gland is located in the brain and manufactures the hormone ACTH, which stimulates the adrenal gland to produce cortisone. Radiation can sometimes stop the formation of excess amounts of ACTH, thus decreasing the amount of cortisone.
Too much cortisone medication can cause the same symptoms as Cushing’s disease or excessive adrenal hormone production. When cortisone treatment is required, as in rheumatoid arthritis or asthma, the pills sometimes can be taken every two days instead of every day to decrease some of the side effects. Your physician can monitor your treatment and check the effects.
Some illnesses cause the adrenal glands to stop working partially or completely. The adrenal glands can be affected by a tuberculosis infection or by a tumor. Or the glands may stop producing cortisone for no apparent reason.
If you lack cortisone, you will probably feel weak and have little energy. You may lose weight or be found to have low blood pressure. The color of your skin may darken even when you have not been in the sun. Nausea, loss of appetite, and frequent vomiting also can occur. This illness, known as Addison’s disease, progresses slowly, but it may become serious under stressful situations. If, for instance, you require surgery and an anesthetic, a lack of cortisone can lead to severe complications. Any physician or surgeon should be made aware that you suffer from Addison’s disease so that cortisone can be given before surgery.
If you are receiving cortisone pills or injections, or know that you have Addison’s disease, it is important for you to wear a Medic-Alert® bracelet that says you are receiving cortisone therapy. The main danger is that during a serious illness, infection, or surgery, your body may not be able to produce enough cortisone to meet the body’s requirements. Because your adrenal glands have shut off, you may go into shock because of the stress. In an emergency situation the physician will temporarily increase the amount of cortisone.
The diagnosis of Addison’s disease is made through blood tests, which will show whether the electrolytes are abnormal and whether the amount of cortisone is sufficient. Cortisone, usually given as pills, is the treatment for Addison’s disease, and it must be continued for life.
If you are receiving cortisone by injection or pills for illnesses such as asthma or rheumatoid arthritis, the adrenal glands may become underactive. In effect, they “think” that they have sufficient cortisone and therefore shut off their own production. If you stop taking the cortisone medication suddenly, the adrenal glands do not have enough time to produce their own supply to replace the lost cortisone. This leads to a drop in blood pressure, general weakness, and often nausea and vomiting. If left untreated, it can lead to shock just as in Addison’s disease.
*240\166\2*
