What disease of the adrenal glands is evidenced by darkening of the skin without sunburn?

The adrenal glands are endocrine glands that secrete epinephrine and norepinephrine through their medulla and glucocorticoids, mineralocorticoids and steroid hormones through their cortex. With pathological processes in the adrenal glands, the release of hormones changes or even stops. This is how adrenal insufficiency develops, which is primary and secondary. It is very difficult to recognize the process due to the gradual course and non-specific symptoms. What processes provoke adrenal insufficiency? How to diagnose diseases of the adrenal glands in time?

Causes of adrenal disease. Addison's disease

Adrenal gland diseases are manifested against the background of atrophy of the adrenal tissue. This may be against the background of inflammatory processes after severe infections, hemorrhage in the adrenal glands after an embolism or thrombosis of the adrenal arteries, destruction of adrenal granulomas, tumors in the adrenal glands, amyloidosis. In most cases, adrenal diseases develop against the background of an autoimmune process in the cells of the adrenal gland, which causes damage to the function of the organ. This is how primary adrenal insufficiency develops - Addison's disease.

Addison's disease occurs at a rate of 4 cases per 100,000 population per year. The disease affects people of different age groups and gender.

Processes occurring in the adrenal glands in Addison's disease

Addison's disease is characterized by insufficient synthesis of the hormones mineralocorticoids and glucocorticoids by the adrenal glands.

• Glucocorticoid deficiency. The lack of glucocorticoids contributes to the development of hypotension. Carbohydrate, protein and fat metabolism is disturbed. Changes in insulin sensitivity. In the absence of cortisol, carbohydrates begin to be synthesized from proteins. This is how hypoglycemia develops and the store of glycogen in the liver decreases. Therefore, patients develop severe weakness and insufficiency of neuromuscular functions.

 With a deficiency of glucocorticoids, the  immune response of the body to infections, stressful situations and injuries worsens. Therefore, patients with diseased adrenal glands often suffer from various infectious diseases, and are also prone to depression.

Reduced levels of cortisol in the blood contribute to an increase in the production of ACTH and an increase in blood beta - lipotropin. Beta-lipotropin has melanocyte-stimulating activity. So there is a typical hyperpigmentation of the skin and mucous membranes, characteristic of Addison's disease. Therefore, secondary adrenal insufficiency is never accompanied by hyperpigmentation.

• Mineralocorticoid deficiency. The lack of synthesis of these hormones by the adrenal glands leads to an increase in the excretion of sodium and a decrease in the excretion of potassium in the urine, sweat and saliva. As a result, there is a high level of potassium and low sodium in the blood.

Against this background, an electrolyte imbalance appears, which, together with the inability to concentrate urine, provokes severe dehydration. Plasma hypertonicity increases, acidosis develops, BCC decreases. Hypotension and circulatory collapse develops.

But with adrenal insufficiency associated with impaired ACTH synthesis, electrolyte levels can often remain within the normal range.

Manifestations of adrenal disease. Symptoms of Addison's disease

Manifestations of diseases of the adrenal glands are characterized by a gradual and slow onset, a large number of non-specific symptoms that rarely make the patient see a doctor, because they look like & nbsp; simple overwork. And when contacting a doctor, specific tests are rarely prescribed to detect adrenal insufficiency. Therefore, often the disease of the adrenal glands at first remains undiagnosed.

There is a characteristic symptom of Addison's disease that, without testing, indicates possible problems with the adrenal glands. This is hyperpigmentation of the skin. Darkening of the entire surface of the skin is observed. In this case, the skin acquires a bronze tint, very similar to that which occurs after a regular tan. Often there are age spots on the face, neck and shoulders. A bluish-black staining of the nipples, lips, mouth appears, and areas of vitiligo also appear.

In Addison's disease, patients often have increased susceptibility to cold due to a decrease in the intensity of metabolic processes. Often this is accompanied by dizziness and loss of consciousness (against the background of electrolyte imbalance).

With prolonged progression of this disease of the adrenal glands, marked dehydration, weight loss and hypotension are noted.

Algorithm and methods for diagnosing diseases of the adrenal glands

Diagnosis of diseases of the adrenal glands is carried out on the basis of a general and biochemical blood test, as well as on the basis of the clinical picture. In the biochemical analysis of blood, a low level of sodium (below 135 mEq / L) and an increased concentration of potassium (more than 5 mEq / L) are observed.

So, the ratio of sodium to potassium is 30:1. Fasting glucose levels are low (less than 2.78 mmol/l). There is high urea (greater than 20 mg/dl) and low HCO3 (less than 20 mEq/l).

In the general analysis of blood in case of adrenal insufficiency, leukopenia, high hematocrit, eosinophilia and relative lymphocytosis are observed.

But the most important thing in making a diagnosis is the correct history taking and assessment of complaints.

History to help recognize adrenal insufficiency

Remember, if you have a patient in front of you, who looks asthenic and thin, who has a skin color like after a long sea tan, this indicates a possible disease of the adrenal glands. Therefore, it is necessary to clarify the symptoms.

For this, it is advisable to ask how the patient sleeps, whether he gets enough sleep. If the patient says that he wakes up completely unrested, weakness is constantly present and increases – such a patient should be urgently evaluated for an adrenal disease such as Addison's disease.

Often people are embarrassed by the progressive darkening of the skin in winter when there is no sun, unreasonable weight loss, cravings for salty foods and severe weakness throughout the body, which does not decrease even after prolonged sleep. Dizziness and loss of consciousness are often present, which patients cannot associate with anything. It is with these complaints that a patient with Addison's disease comes to see a doctor.

Addison's disease with symptomatic treatment (hormone replacement therapy) is well compensated and does not affect the length and quality of life of the patient.