Symptom >> Internal Medicine >> Endocrinology

Mineralocorticoid secretion is too low

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Mineralocorticoid: mainly acts on sodium, potassium, chloride and water metabolism, so it is called mineralocorticoid. Among these hormones are aldosterone and deoxycorticosterone, among which aldosterone is the strongest. Mineralocorticoids have the effect of preserving sodium and potassium, promoting the reabsorption of sodium by the renal tubules and the effect of potassium release, thereby maintaining the proper concentration of sodium and potassium in the plasma. When the adrenal cortex hyperfunction (such as Cushing's syndrome), 11-deoxycorticosterone secretion, due to retention of sodium and water in the body beyond the limits of edema, increased blood volume, elevated blood pressure, high blood sugar, hypokalemia Wait. Conversely, if the adrenal cortical function is insufficient, the metabolism of sugar and minerals is disordered, causing a bronze disease, or "Addison's disease", which shows muscle weakness, decreased blood pressure, skin pigmentation and hypoglycemia, blood. Symptoms such as decreased sodium and increased potassium, while blood loses water and concentrates, and are life-threatening in severe cases.

Cause

Cause

The cause of too little secretion of salt corticosteroids

Adrenal cortical function is insufficient, such as Addison's disease. Addison's disease Addison, also known as primary chronic adrenal insufficiency, is caused by bilateral adrenal atrophy, tuberculosis and other serious infections or tumors, most of which are due to tuberculosis destroying the adrenal cortex or bilateral adrenal glands. The disease caused by insufficient secretion of the adrenal cortex hormone caused by most or all of the cortex may also be caused by the secretion of CRH in the hypothalamus and the lack of ACTH secretion from the pituitary gland, but it is more common in the adrenal gland itself. In addition, autoimmune diseases, severe trauma can also destroy or atrophy of the adrenal cortex; the rest are amyloidosis, tumors, syphilis, fungi, thrombosis, etc. can also destroy the adrenal cortex and affect its function.

Examine

an examination

Related inspection

Adrenocorticotropic hormone (ACTH) urinary adrenaline adrenal cortical imaging adrenal medullary imaging adrenal MRI

Examination and diagnosis of too little secretion of salt corticosteroids

The disease is often insidious, and the first symptoms are unexplained gastrointestinal symptoms such as loss of appetite, abdominal pain, and diarrhea. Normal gastrointestinal motility is probably related to adrenal function to some extent, but the relationship between the two remains unclear. In addition to gastrointestinal symptoms, it can also be weak, weak, weight loss, hyperpigmentation and decreased blood pressure.

The majority of patients are middle-aged and young, mostly between the ages of 20 and 50. The prevalence of men and women is almost equal, and the number of women with unknown causes is more.

After the strict use of endocrine therapy, antispasmodic and other treatments, the patient's life span is greatly prolonged, the labor force is also significantly restored, and can be close to normal people. Follow-up observation continued treatment for more than 7 years, some patients can normal pregnancy and childbirth, but should pay attention to prevention and treatment of adrenal crisis during childbirth. Pediatric growth and development before and after childbirth are completely normal. During the treatment, the patient's resistance is low, prone to respiratory infections, gastrointestinal disorders, and even the adrenal crisis, should be noted.

The skin of Addison's disease is brown-black pigmentation in the skin and mucous membranes, which is most obvious in exposure, compression and friction, such as forehead, eye circumference, limb flexion, shoulder, ankle, waist, hip fold and palmar skin. Lines and other places. Brown pigmentation spots may also appear on mucous membranes such as lips, buccal mucosa, gums, nipples, areola, and external genitalia. In addition to skin manifestations, the disease also has symptoms such as fatigue, lack of appetite, loss of appetite, dizziness, palpitations, decreased blood pressure, nausea, abdominal pain, memory loss, confusion of thought, depression, irritability and so on. The disease is often accompanied by other endocrine disorders such as hypoglycemia, hypothyroidism, and decreased sexual function.

Laboratory tests showed that blood sodium was reduced, blood potassium was elevated, and the ratio of blood to sodium, potassium, and potassium was less than 30. Serum chloride is reduced and blood sugar is lowered. X-ray, the adrenal gland shows calcification.

In addition to treatment, you should eat more lean meat, milk, eggs and fresh vegetables in your diet, and eat more sodium.

The clinical manifestations are the symptoms caused by cortisol deficiency: generalized weakness, weakness and weight loss, skin, mucous membrane pigmentation, obvious pigmentation at the exposed parts of the skin and joint folds, and pigmentation in the mouth, lips, tongue and buccal mucosa, female The pubic hair is reduced and the male sexual function is reduced.

Severe cases can lead to adrenal crisis, often occurring in stress, infection, surgery, childbirth, overwork, excessive sweating or sudden interruption of treatment. It is characterized by nausea, vomiting, diarrhea, severe dehydration, lower blood pressure, fast heart rate, weak pulse, often high fever, hypoglycemia, hyponatremia, etc., which can be life-threatening.

The diagnosis of Addison's disease depends mainly on the determination of blood cortisol and blood ACTH levels.

Patients with well-diagnosed need a lifetime replacement therapy for corticosteroids (cortisone), and need to increase the amount of stress such as infection.

Diagnosis

Differential diagnosis

Symptoms of salt corticosteroid secretion are too small to be confused

1. Simple obesity and type 2 diabetes: may have obesity, hypertension, abnormal glucose metabolism, menstrual disorders, skin white lines, etc., blood cortisol and its metabolites are increased, but can be inhibited by low-dose dexamethasone, cortex Alcohol and ACTH rhythm are normal.

Second, pseudo Cushing syndrome: alcoholic liver damage, not only various symptoms and hormone levels similar to this disease, and no response to small doses of dexamethasone or reduced response, but abstinence can be restored.

Third, depression: Although the increased hormone and its metabolites are not inhibited by small doses of dexamethasone, but no clinical manifestations of Chushing syndrome.