What is tertiary adrenal cortex insufficiency?
In the literature, adrenal cortex hypofunction resulting from the inadequate intake or incorrect dose reduction of cortisol is often referred to as tertiary adrenal cortex insufficiency. In many cases, especially inflammatory diseases, cortisol can improve the symptoms. If cortisol is suddenly discontinued, the body’s lack of self-production can lead to adrenal insufficiency.
Causes of tertiary adrenal cortex insufficiency
Cortisol can alleviate the symptoms of many diseases. Cortisol therapy, which is administered over a longer period of time, reduces the body’s own production of the hormone. The externally administered cortisol inhibits in particular the release of ACTH, also known as adrenocorticotropic hormone.
This hormone is produced in the pituitary gland and acts naturally on the adrenal cortex, where it stimulates the production of the body’s own cortisol and the sex hormones androgens. Over time, the suppressed cell function leads to tissue loss of the ACTH-producing areas in the pituitary gland and partially also in the adrenal cortex. If this leads to a sudden cessation or reduction in the dose of cortisol, the body cannot resume its function. The result is a cortisol and androgen deficiency, which is also called tertiary adrenal cortex insufficiency due to its origin.
Diagnostics
To diagnose adrenal insufficiency, in addition to a physical examination, it is also necessary to determine specific blood values. Especially the cortisol concentration in the blood and the amount of ACTH are crucial parameters. In tertiary adrenal insufficiency, the cortisol level is reduced, as is the ACTH level.
Furthermore, imaging techniques such as ultrasound or computer tomography are used. These primarily serve to exclude other possible causes such as tumorous disease. In women, the androgen value (value of sex hormones) can also be determined, which is also lower in the case of tertiary adrenal insufficiency.
Symptoms of tertiary adrenocortical insufficiency
Typical symptoms of tertiary adrenal cortex insufficiency are
- Too low blood pressure
- Weight loss
- Powerlessness or exhaustion
- Pale skin
- In women due to androgen deficiency, decrease in desire sensation (loss of libido)
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