PRAYER

M K AM K A R TI
VAC LAM

P A N G U M LA N G H A YA T
G IR IM

Y A T K R IP T A M A H A M
VAN D
 Name of the disease & terminologies
Etiology
History, signs and symptoms
Physical examination
Investigation
Treatment according to allopathic medicine
Other therapies
Yoga practices
Books and journals for reference
 ALTERNATIVE NAMES
Addison disease
Adrenocortical hypofunction
Chronic adrenocortical insufficiency
Adrenal insufficiency
 INTRODUCTION
Either of two small, dissimilarly shaped
endocrine glands, one located above each
kidney, consisting of the cortex, which
secretes several steroid hormones, and the
medulla, which secretes epinephrine.
Also called suprarenal gland.
The adrenal glands, located on the cephalad
portion of each kidney, consist of a cortex and
medulla, each with separate endocrine
functions.
 The adrenal cortex produces glucocorticoids
(primarily cortisol), mineralocorticoids
(primarily aldosterone), and androgens
(primarily dehydroepiandrosterone and
androstenedione).
Glucocorticoids promote and inhibit gene
transcription in many cells and organ systems.
Prominent effects include anti-inflammatory
actions and increased hepatic
gluconeogenesis.
Mineralocorticoids regulate electrolyte
transport across epithelial surfaces,
particularly renal conservation of Na in
exchange for K.
 Adrenal androgens' chief physiologic activity
occurs after conversion to testosterone
Physiology of the pituitary-corticoadrenal
system is further discussed in Principles of
Endocrinology and discussed in Pituitary
Disorders.
The adrenal medulla is composed of
chromaffin cells, which synthesize and secrete
catecholamines (mainly epinephrine and lesser
amounts of norepinephrine
Chromaffin cells also produce bioactive
amines and peptides (eg, histamine, serotonin,
chromogranins, neuropeptide hormones).
 Epinephrine and norepinephrine the major
effector amines of the sympathetic nervous
system, are responsible for the flight or fight
response (ie, chronotropic and inotropic
effects on the heart; bronchodilation;
peripheral and splanchnic vasoconstriction
with skeletal muscular vasodilation; metabolic
effects including glycogenolysis, lipolysis, and
renin release).
Most deficiency syndromes affect output of all
adrenocortical hormones.
 Hypofunction may be primary (malfunction of
the adrenal gland itself, as in Addison's
disease) or secondary (due to lack of adrenal
stimulation by the pituitary or hypothalamus,
although some experts refer to hypothalamic
malfunction as tertiary).
Hyperfunction produces distinct clinical
syndromes.
Hypersecretion of androgens results in adrenal
virilism; of glucocorticoids, Cushing's
syndrome; and of aldosterone,
hyperaldosteronism (aldosteronism).
 These syndromes frequently have overlapping
features.
Hyperfunction may be compensatory, as in
congenital adrenal hyperplasia, or due to
acquired hyperplasia, adenomas, or
adenocarcinomas.
Excess quantities of epinephrine and
norepinephrine are produced in
pheochromocytoma
 Addison's disease is a hormone deficiency
caused by damage to the outer layer of the
adrenal gland (adrenal cortex).
Addison's disease is a disorder that results in
the body producing insufficient amounts of
certain hormones produced by the adrenal
glands.
The adrenal glands are located just above each
of two kidneys.
These glands are part of the endocrine system,
and they produce hormones that give
instructions to virtually every organ and tissue
in the body.
 In Addison's disease, adrenal glands produce too
little cortisol, which is one of the hormones in a
group called the glucocorticoids.
Sometimes, Addison's disease also involves
insufficient production of aldosterone, one of the
mineralocorticoid hormones.
Addison's disease can be life-threatening.
Also called adrenal insufficiency or
hypocortisolism, Addison's disease can occur at
any age, but is most common in people ages 30 to
50.
Treatment for Addison's disease involves taking
hormones to replace the insufficient amounts being
made by adrenal glands.
 ETIOLOGY
About 70% of cases in the US are due to idiopathic
atrophy of the adrenal cortex, probably caused by
autoimmune processes.
The remainder result from destruction of the adrenal
gland by granuloma (eg, TB), tumor, amyloidosis,
hemorrhage, or inflammatory necrosis.
Hypoadrenocorticism can also result from
administration of drugs that block corticosteroid
synthesis (eg, ketoconazole, the anesthetic
etomidate).
Addison's disease may coexist with diabetes mellitus
or hypothyroidism in polyglandular deficiency
syndrome.
 SIGNS AND SYMPTOMS
Signs and symptoms of Addison's disease usually
develop slowly, often over several months, and may
include:
Muscle weakness and fatigue
Weight loss and decreased appetite
Darkening of the skin (hyperpigmentation)
Low blood pressure, even fainting
Salt craving
Low blood sugar (hypoglycemia)
Nausea, diarrhea or vomiting
Irritability
Depression
Sometimes, however, the signs and symptoms of
Addison's disease may appear suddenly.

In acute adrenal failure (addisonian crisis), the

signs and symptoms may also include:

Pain in the lower back, abdomen or legs

Severe vomiting and diarrhea, leading to
dehydration
Low blood pressure
Loss of consciousness
 CAUSES
Adrenal glands are composed of two sections.
The interior (medulla) produces adrenaline-
like hormones.
The outer layer (cortex) produces a group of
hormones called corticosteroids, which
include glucocorticoids, mineralocorticoids
and male sex hormones (androgens).
Some of the hormones the cortex produces are
essential for life the glucocorticoids and the
mineralocorticoids.
 Glucocorticoids. These hormones influence
the body's ability to convert food fuels into
energy, play a role in the immune system's
inflammatory response, and help body respond
to stress.

Mineralocorticoids. These hormones

maintain the body's balance of sodium and
potassium and water to keep blood pressure
normal.
 Primary adrenal insufficiency
Addison's disease occurs when the cortex is
damaged and doesn't produce its hormones in
adequate quantities.
Doctors refer to the condition involving damage to
the adrenal glands as primary adrenal insufficiency.
The failure of the adrenal glands to produce
adrenocortical hormones is most commonly the
result of the body attacking itself (autoimmune
disease).
For unknown reasons, immune system views the
adrenal cortex as foreign, something to attack and
destroy.
Other causes of adrenal gland failure may
include:
Tuberculosis
Other infections of the adrenal glands
Spread of cancer to the adrenal glands
Bleeding into the adrenal glands
 Secondary adrenal insufficiency
Adrenal insufficiency can also occur if the
pituitary gland is diseased.
The pituitary gland makes a hormone called
adrenocorticotropic hormone (ACTH), which
stimulates the adrenal cortex to produce its
hormones.
Inadequate production of ACTH can lead to
insufficient production of hormones normally
produced by adrenal glands, even though
adrenal glands aren't damaged.
Doctors call this condition secondary adrenal
insufficiency.
 Another more common possible cause of
secondary adrenal insufficiency occurs when
people who take corticosteroids for treatment
of chronic conditions, such as asthma or
arthritis, abruptly stop taking the
corticosteroids.

Addisonian crisis
Addisonian crisis may be provoked by
physical stress (such as injury, infection or
illness), if Addison's disease is untreated
WHEN TO SEEK MEDICAL ADVICE
If severe fatigue, unintentionally lost weight,
feel progressively weaker, experience
abdominal pain, fainting spells and the skin
has become darker, see the doctor to
determine whether Addison's disease or some
other medical condition may be the cause.
 Adrenal glands, located above each of kidneys, produce a number of
hormones, among them the glucocorticoids and the mineralocorticoids.
 SCREENING AND DIAGNOSIS
Doctor will talk first about the medical history
and the signs and symptoms.

If doctor thinks that patient may have Addison's

disease, may undergo some of the following
tests:
Blood test.
ACTH stimulation test.
Insulin-induced hypoglycemia test.
Imaging tests.
 Blood test

Measuring blood levels of sodium, potassium,

cortisol and ACTH gives the doctor an initial
indication of whether adrenal insufficiency
may be causing the signs and symptoms.
A blood test can also measure antibodies
associated with autoimmune Addison's
disease.
 ACTH stimulation test

This test involves measuring the level of

cortisol in the blood before and after an
injection of synthetic ACTH.
ACTH signals adrenal glands to produce
cortisol.
If adrenal glands are damaged, the ACTH
stimulation test shows that the output of
cortisol in response to synthetic ACTH is
blunted or nonexistent.
 Insulin-induced hypoglycemia test

Occasionally, doctors suggest this test if

pituitary disease is a possible cause of adrenal
insufficiency (secondary adrenal
insufficiency).
The test involves checking the blood sugar
(blood glucose) and cortisol levels at various
intervals after an injection of insulin.
In healthy people, glucose levels fall and
cortisol levels increase.
 Imaging tests

Computerized tomography (CT) scan of the

abdomen to check the size of adrenal glands
and look for other abnormalities that may give
insight to the cause of the adrenal
insufficiency.
And may also suggest a CT scan or magnetic
resonance imaging (MRI) scan of the pituitary
gland if testing indicates the patient have
secondary adrenal insufficiency.
 Test Results Suggesting Addison's Disease

Blood Low serum Na (< 135 mEq/L)

chemistry High serum K (> 5 mEq/L)
Ratio of serum Na:K: < 30:1
Low fasting blood glucose (< 50 mg/dL
[< 2.78 mmol/L])
Decreased plasma HCO3 (< 20 mEq/L)
Elevated BUN (> 20 mg/dL [> 7.1 mmol/
L])
Hematology Elevated Hct
Low WBC count
Relative lymphocytosis
Increased eosinophils
Imaging Evidence of:
tests Calcification in the adrenal areas
Renal TB
Pulmonary TB
 TREATMENT
If patient receive an early diagnosis of Addison's
disease, treatment may involve taking
prescription corticosteroids.
Because the body isn't producing sufficient
steroid hormones, doctor may have recommend to
take one or more hormones to replace the
deficiency.
Cortisol is replaced using hydrocortisone
(Cortef), prednisone or cortisone. Fludrocortisone
(Florinef) replaces aldosterone, which controls
the body's sodium and potassium needs and keeps
the blood pressure normal.
 In addition, doctor may recommend treating androgen
deficiency with an androgen replacement called
dehydroepiandrosterone.
Some studies indicate that, for women with Addison's
disease, androgen replacement therapy may improve
overall sense of well-being, libido and sexual
satisfaction.
These hormones are given orally in daily doses that
mimic the amount body normally would make, thereby
minimizing side effects.
If facing a stressful situation, such as an operation, an
infection or a minor illness, doctor will suggest a
temporary increase in dosage.
If ill with vomiting and can't retain oral medications,
may need corticosteroid injections.
 Addisonian crisis

An addisonian crisis is a life-threatening

situation that results in low blood pressure,
low blood levels of sugar and high blood
levels of potassium.
This situation requires immediate medical
care.
Treatment typically includes intravenous
injections of:
Hydrocortisone
Saline solution
Sugar (dextrose)
 COPING SKILLS
Carry a medical alert card and bracelet at all
times. In the event incapacitated, emergency
medical personnel know what kind of care is
needed.

Stay in contact with doctor. Keep an ongoing

relationship with doctor to make sure that the
doses or replacement hormones are adequate
but not excessive. If patient is having
persistent problems with medications, may
need adjustments in the doses or timing of the
medications.
 Keep extra medication handy. Because
missing even one day of therapy may be
dangerous, it's a good idea to keep a small
supply of medication at work, at a vacation
home and in travel bag in the event patient
may forget to take pills. Also, have doctor
prescribe a needle, syringe and injectable form
of corticosteroids to have with in case of an
emergency.
 YOGA PRACTICES
YOGA IS BALANCE (SAMATVAM)
I A Y T CORRECTS IMBALANCES
AIMS :
STRESS REDUCTION
RELIEF OF PAIN
MEDICATION REDUCTION
 INTEGRATED YOGA MODULE FOR
DISORDERS OF ADRENAL CORTEX
Breathing exercise
Folded leg lumbar stretch
Crossed leg lumbar stretch
Pavanamuktasana lumbar stretch
Setubandhasana lumbar stretch
Dorsal stretch
Tiger breathing
Sasankasana breathing
Bhujangasana breathing
Straight leg raising (alternate legs)
Side leg lumbar stretch
Relax in Makarasana
Yogasanas
Ardhakaticakrasana
Viparitakarani (with wall support)
Matsyasana
Ustrasana
Deep relaxation technique (DRT)
Pranayama
Vibhaga pranayama (sectional breathing)
Nadi suddhi
Sitali/ Sitkari/ Sadanta pranayama
Bhramari
Meditation (Dhyana Dharana)
Nadanusandhana
OM meditation
Kriyas
Jala Neti
Sutra Neti
SPECIFIC PRACTICES