What is it about ?
Hypocortisolism refers to a deficiency in cortisol. It is also called Addison’s disease or bronzing disease, because it causes brownish pigmentation in the skin.
Cortisol is a natural type of cortisone, which is produced in the adrenal gland. The functioning of the adrenal gland is in turn controlled by hormones produced in the pituitary gland (pituitary gland). We also know cortisol as a “stress hormone” because it is produced in greater amounts under the influence of stressful situations.
Cortisol is very important for the metabolism. In particular, it regulates the breakdown of carbohydrates, lipids (fats) and proteins. In addition, it plays a role in regulating our natural resistance (immunity). High cortisol volumes inhibit resistance.
A cortisol deficiency can be due to affections of the adrenal gland (congenital diseases, infections, tumors, bleeding), disorders of the pituitary gland (infections, tumors, trauma, bleeding, etc.) and finally to the administration of long-lasting (high) cortisone doses. In the latter case, the body incorrectly receives the signal that there is enough cortisol, and blocks its production by the adrenal gland.
What is its frequency?
Hypocortisolism is very rare. Estimates vary from 1 in 100,000 people to 120 in 1,000,000 cases.
How to recognize it?
Usually, symptoms progress slowly. These are: fatigue, lack of energy, loss of appetite and weight loss, nausea, low blood pressure and brownish pigmentation of the skin and mucous membranes. More rarely: abdominal pain, diarrhea or constipation, fainting, craving for salt and whitish spots on the skin (vitiligo).
Addison’s crisis can occur with severe deficiencies. An Addison’s crisis manifests itself in the short term as life-threatening saline imbalances in the blood, accompanied by a drop in blood pressure and blood circulation failures which results in shock. This kind of crisis does not necessarily occur in the chronic form of Addison’s disease. It can also come on suddenly, for example after bleeding from the adrenal gland.
How is the diagnosis made?
The diagnosis is based almost entirely on a blood test confirming cortisol deficiency. Often the blood test also shows a sodium deficiency. It can also detect infections and low glucose levels. If the cortisol values do not provide sufficient certainty about the diagnosis, an ACTH test may be performed. For this test, a drug (synacthene) is injected to see if the body is producing enough cortisol in response. For the detection of bleeding and tumors, radiological examinations, such as a CT scan, should be performed.
What can you do ?
The general symptoms and the rarity of the disease do not immediately suggest hypercortisolism. You can’t do much about it either. This is why, in the event of persistent complaints, it is best to consult your general practitioner. In the presence of a high loss of salt and / or in case of diarrhea and heavy sweating (sport), additional salt intake may be useful.
What can your doctor do?
The doctor will first correct the cortisol deficiency with cortisone replacement therapy. This means that a medicine will compensate for what your body does not produce on its own. The dose is adjusted according to your needs. Thus, a higher dose is necessary in case of pregnancy or intense efforts. If possible, the doctor will also treat the cause (infection or tumor). An Addisonian crisis requires urgent hospitalization. In addition to the administration of cortisone, abnormalities in salt balance, blood pressure and shock are also taken care of.