Therapy

The treatment of the tertiary form of adrenal cortex insufficiency is the same as for primary and secondary forms, with the administration of cortisol. The amount of cortisol should also be adjusted to the physical strain, i.e. the cortisol must be administered in higher doses in certain situations that put the body under stress. These include, for example, fever, high physical demands due to sporting activity, trauma, severe stress, etc. In women, the administration of a steroid hormone may also be necessary. This is a substrate for oestrogen and testosterone production and can be taken by affected women, especially if they lose sexual desire.

Prognosis of tertiary adrenocortical insufficiency

Tertiary adrenal insufficiency is generally well treatable. The renewed administration of cortisol compensates for the cortisol deficiency and the symptoms usually disappear again quickly. The tissue loss in the pituitary gland, which was previously caused by long-term therapy with cortisol in advance, remains. As in secondary adrenal insufficiency, the pituitary gland is then no longer able to properly secrete ACTH and consequently no cortisol production takes place in the adrenal cortex. Those affected are therefore still dependent on therapy with cortisol, as their own body can no longer properly fulfil its function.

Course of disease

The symptoms can be alleviated well by a regular cortisol therapy. However, a cure for tertiary adrenal insufficiency is not possible. The intake of cortisol or the amount of cortisol must be adapted to specific situations by those affected. For example, a cold with fever, severe stress or intense physical activity.Increased intake in these life situations is particularly important to avoid complications, especially the Addison crisis. This can manifest itself in adrenal insufficiency through a severe cortisol deficiency and requires immediate medical treatment.

Difference to primary adrenal cortex insufficiency

In primary adrenocortical insufficiency, the loss of function is usually caused by an adrenaline reaction of the body. The body destroys the tissue of the adrenal cortex through misdirected processes. This is also known as autoimmune adrenalitis.

The function of the adrenal cortex is disturbed and hormone production fails. In addition to cortisol and androgen deficiency, the production of another hormone, aldosterone, also fails to occur. This mainly affects the water and salt balance of the body.

The symptoms of primary and tertiary hypofunction are very similar, except for a few subpoints. In contrast to the tertiary form, a darkening of the skin is typical in primary insufficiency. In addition, the primary form may have a low sodium level and an increased potassium level in the blood due to the aldosterone deficiency involved.