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The syndrome of hypocorticism (chronic insufficiency of the adrenal cortex) is caused by insufficient secretion of hormones of the adrenal cortex in case of damage (primary hypocorticism) or disorders of the hypothalamic-pituitary regulation (secondary and tertiary hypocorticism).

Hormones that are synthesized in the adrenal cortex are corticosteroids. The adrenal cortex itself morpho-functionally consists of three layers(zones), each of which produces certain kind hormones:

The zona glomeruli is responsible for the production of hormones called mineralocorticoids (aldosterone, corticosterone, deoxycorticosterone).
The zona fasciculata is responsible for the production of hormones called glucocorticoids (cortisol, cortisone)
The reticular zone is responsible for the production of sex hormones (androgens).

Etiology and pathogenesis

Primary hypocorticism (Addison's disease). Predisposing factors - autoimmune diseases of a different nature with the involvement of the adrenal cortex in the process, tuberculosis process, amyloidosis, HIV infection, syphilis and fungal diseases. Metastases may be the cause of hypocorticism cancerous tumors. hereditary predisposition realized through violations of the immune control system. There is an association with antigens of the system HLAB 8 and DW 3 , DR 3 , A 1 .

Primary hypocorticism is based on atrophy of the adrenal cortex, most often as a result of an autoimmune process (autoimmune adrenalitis). In this case, immunological tolerance to cortical tissue is disturbed, which is accompanied by the development of organ-specific reactions. Tissue specificity is determined by antigens contained in the cellular structures of the adrenal cortex. When they enter the blood, antibodies are formed to the key enzyme of steroidogenesis - 21-hydroxylase, which serve as specific markers of the disease.

At histological examination in the adrenal cortex, atrophy of the parenchyma, fibrosis, lymphoid infiltration, predominantly in the glomerular or fascicular zones. In this regard, the number of cells producing glucocorticoids (cortisol) and mineralocorticoids (aldosterone) decreases.

Secondary hypocorticism. Secondary insufficiency of the adrenal cortex develops with brain tumors, after surgery, traumatic brain injury, with autoimmune hypophysitis, thrombosis of the cavernous sinus, after massive bleeding. The pathogenesis is based on insufficient secretion of corticotropin. Usually combined with insufficiency of other tropic pituitary hormones (gonadotropins, thyrotropin). At long-term treatment glucocorticoid drugs of various diseases also develops at first secondary adrenal insufficiency with inhibition of corticotropin secretion according to the law feedback. Long-term therapy can lead to atrophy of the adrenal cortex.

Tertiary hypocorticism occurs with a decrease in the secretion of corticoliberin due to a tumor or ischemia of the hypothalamic region, after radiotherapy, operations, at anorexia nervosa, intoxication.

Symptoms

Early signs: fatigue and weakness in the afternoon, hypersensitivity to the action of sunlight with persistent sunburn, a decrease in resistance to infections and a protracted course colds, loss of appetite.

deployed clinical symptoms is very typical and is characterized by pigmentation of the skin and mucous membranes from golden to grayish hues, especially in places of friction ( armpits, groin area, hands and elbows, lips and oral mucosa, scars and scars). There are persistent arterial hypotension, tachycardia, dyspeptic disorders, abdominal pain, weight loss, severe muscle weakness, which makes it difficult to move even at a slow pace.

Specific features: increased need in salt and a tendency to hypoglycemic reactions. Clinical symptoms due to a lack of glucocorticoids (muscle weakness, dyspeptic disorders, weight loss, hypoglycemia), mineralocorticoids (need for salty foods, arterial hypotension) and increased secretion of melanocytotropin (proopiomelanocortin). Expressed Clinical signs develop when more than 80% of the tissue of the adrenal cortex is damaged.

Primary hypocorticism can be combined with candidiasis, type 1. With secondary and tertiary hypocorticism, clinical symptoms are less pronounced, pigmentation, as a rule, is absent. Clear signs of the disease can appear only in stressful situations.

Diagnostics

Diagnostic criteria: pigmentation, weight loss, arterial hypotension (a feature of which is an inadequate response to physical activity in the form of a decrease in blood pressure), a decrease in plasma cortisol (5 mmol / l), a decrease in serum sodium levels (100 ng / ml at primary hypocorticism and its decrease in the secondary.

AT initial stages used to verify the diagnosis functional tests: test with synacthen-depot (synthetic analog of long-acting corticotropin). The test procedure is as follows: 1 mg of the drug is injected intramuscularly after blood sampling to study the basal level of cortisol. A second blood test for cortisol is carried out after 24 hours. A sign of primary hypocorticism is the absence of an increase in the content of cortisol in the blood after stimulation with synacthen. With secondary hypocorticism, the concentration of cortisol increases markedly.

The test with long-term stimulation of the adrenal glands with synacthen depot is carried out intramuscularly daily for 5 days at a dose of 1 mg. Free cortisol in the daily urine is determined both before the administration of the drug, and during the 1st, 3rd and 5th days of stimulation of the adrenal cortex. In healthy people, the content of free cortisol in daily urine increases by 3-5 times from the initial level. In case of secondary insufficiency, on the contrary, on the 1st day of stimulation with synacthen-depot, there may not be an increase in the content of free cortisol in the daily urine, and on the next 3rd and 5th days it reaches normal values.

Differential diagnosis is carried out with conditions accompanied by hyperpigmentation, weakness, arterial hypotension, slimming:

diffuse toxic goiter
- Common signs: weakness, weight loss, pigmentation.
- Differences in toxic diffuse goiter: arterial systolic pressure increased, and decreased diastolic (increased pulse blood pressure), increased appetite, fine tremor of the fingers, enlarged thyroid gland, atrial fibrillation is possible.
Hemochromatosis
- Common signs: hyperpigmentation, muscle weakness.
- Differences in hemochromatosis: presence, hyperglycemia, increased levels of iron in the blood. However, a study of blood cortisol is mandatory, as there may be a combination of hemochromatosis and hypocorticism.
Chronic enterocolitis
- General signs: weakness, weight loss, abdominal pain, hypotension, anorexia.
- Differences chronic enterocolitis: frequent liquid stool, changes in the coprogram, seasonal exacerbation, the effect of enzyme therapy.
Neurotic syndromes
- General signs: weakness, anorexia, tachycardia.
- Differences: arterial pressure normal or its lability is noted, there is no pigmentation and weight loss, weakness in the morning and improvement in well-being in the evening, inconstancy of symptoms.

Treatment

Treatment is based on stimulation of the synthesis of own hormones and hormone replacement therapy under the control of the following parameters: blood pressure, body weight, color skin, the level of cortisol and corticotropin, the content of potassium and sodium in the blood. Shown diet with high content carbohydrates (at least 60%), a sufficient amount table salt, protein and vitamins; the total caloric content of food should be 20-25% higher than usual.

If it is possible to achieve condition compensation (according to the following criteria) by assigning ascorbic acid at a dose of 1.5 to 2.5 g / day, patients do not need constant hormone therapy (usually with a latent form). In such cases, steroid hormones (glucocorticoids) are prescribed only for a period stressful situations(illness, severe physical activity, nervous tension, surgical intervention).

If signs of the disease persist while taking ascorbic acid, hormones with predominantly glucocorticoid activity are prescribed, preferably natural ones - cortisone, cortisone acetate. The dose of cortisone acetate is selected individually until signs of compensation are achieved (from 25 to 50 mg / day).

If it is not possible to compensate for the condition with glucocorticoid hormones, mineralocorticoids - cortinef (florinef, 0.1-0.2 mg / day) are added to the treatment. Overdose should be avoided to prevent fluid retention and the development of arterial hypertension syndrome.

The main thing in replacement therapy chronic insufficiency adrenal cortex — achievement and preservation of clinical and hormonal compensation of the disease.

Criteria for clinical compensation:

body weight stabilization;
normalization of blood pressure;
elimination of pigmentation of the skin and mucous membranes;
restoration of muscle strength.

Indicators of hormonal-metabolic compensation:

basal plasma cortisol > 350 mmol/l;
potassium level - 4.0-4.5 mmol / l;
sodium level - 135-140 mmol / l;
glycemia from 4.5 to 9.0 mmol / l during the day.

In addition to replacement therapy, etiopathogenetic treatment is prescribed, which depends on the cause of the disease.

With autoimmune genesis, patients receive courses 1-2 times a year of immunocorrective drugs to stimulate the T-suppressor function of the cellular immunity. In order to suppress antibody formation to the enzyme 21-hydroxylase, the dose of glucocorticoids is periodically increased (especially in intercurrent diseases, when the activity of autoaggression increases).

In case of tuberculous etiology, specific anti-tuberculosis therapy is prescribed. In these cases, control over its duration and nature is carried out by a phthisiatrician. The appointment of anabolic steroids is shown.

The adrenal glands are called glands (there are two of them), which are located above the kidneys. The work of the adrenal glands is very important for the functioning of the human body. If these organs do not perform their function correctly, there is a failure in the work of all organs, this failure can lead not only to irreparable consequences for health, but also to death.

The function of the adrenal glands is reduced to the following aspects:

hormone synthesis;
regulation of metabolic processes;
manifestation adequate response for stress;
regulation of the constancy of the internal environment.

The adrenal glands consist of two layers - the cortex and the medulla. In turn, the cortical layer is divided into glomerular, fascicular and reticular, each of which performs its specific function.

The glomerular zone produces the following hormones - corticosteromes, aldosterone, deoxycorticosterone. Corticosterone is synthesized in the fascicular zone, and sex hormones are produced in the reticular zone.

In addition to the synthesis of hormones, the cortical substance regulates water and electrolyte balance, stimulates the work of the heart, is responsible for the expansion of bronchioles, normalizes blood pressure, produces adrenaline and noradrenaline, and increases sugar levels.

The function of the adrenal glands in men, in addition to the above, is as follows:

the functionality of the genital organs;
increase in muscle strength.

The adrenal glands increase the body's resistance to various diseases, increase positive emotions actively help to deal with stress and depressive situations. The hormones that are synthesized by these paired organs are essential for the functioning of the body, any deviation from the norm leads to serious ailments.

How to check the work of the adrenal glands? For verification, there are effective diagnostic methods, which will be discussed below.

Adrenal disorders

Diseases of the adrenal glands are accompanied by an imbalance of hormones (excess or deficiency), but can occur without hormonal failure. A decrease in hormone synthesis is observed in acute and chronic adrenal insufficiency. In this case, the body does not have enough adrenal hormones, as a result of which various ailments develop. The causes of primary adrenal insufficiency may be in the destruction of organ tissue by various infectious diseases(eg tuberculosis). Secondary adrenal insufficiency occurs with reduced functionality of the hypothalamus and pituitary gland.

Excessive synthesis of hormones is observed with tumors, an increase in the cortex of organs, with Itsenko-Cushing's disease. But some violations in their work can proceed without change. hormonal background, These include cystic formations and tumors that do not show hormonal activity.

Symptoms of diseases

Cushing's syndrome is an excess synthesis of hormones. Signs:

the patient has excess weight, and weight gain mainly falls on the front of the torso and face. The limbs lose weight;
stretch marks of purple color are noted on the skin;
the skin is covered with pimples;
women are observed increased hair growth, the loop breaks;
men develop sexual impotence;
weakness;
bones become brittle;
blood pressure rises;
may develop diabetes;
appetite increases;
insomnia, headaches, depression appear.

Addison's disease - insufficient synthesis of hormones. Signs:

increased pigmentation of mucous membranes and skin;
problems with the heart and blood vessels;
loss of appetite;
nausea, diarrhea;
increased thirst;
fatigue;
tremor of the limbs;
anxiety state.

Hyperaldosteronism is an excessive production of aldosterone. Signs:

high blood pressure;
tachycardia, heart pain;
headache;
decreased visual acuity;
severe fatigue;
convulsions;
the kidneys disrupt their work;
swelling;
paresthesia.

Nelson's syndrome - signs:

indigestion;
increased blood pressure;
decrease in blood glucose levels;
prostration;
increase in the Turkish saddle;
skin pigmentation.

Adrenogenital syndrome - the adrenal glands synthesize androgen in excessive quantities:

in women, the voice timbre decreases, muscle mass and genitals increase;
in newborns, height and weight exceed the norm, the body is disproportionate, increased hairiness;
the body structure of girls resembles that of men.

Of course, this is not a complete list of diseases that the adrenal glands are susceptible to, there are a lot of them and it is not possible to list everything at once. If you suspect a failure in their work, you should immediately consult a doctor, undergo examinations and begin therapy.

Diagnostic laboratory measures

The initial symptoms of incorrect work of the adrenal glands are not always bright. Unreasonable thinness, low blood pressure and digestive problems can appear with various ailments. Therefore, doctors recommend taking tests for adrenal hormones for women who take drugs for a long time. birth control pills. Suppressing reproductive function organism, oral contraceptives provoke hormonal imbalance how this affects the work of the adrenal glands depends on which pills are taken, and on the characteristics of the body's reaction to them.

Since the balance of hormones with a problem with the adrenal glands is disturbed, tests for adrenal hormones are first necessary. Before taking tests, the patient must prepare - the day before the study, you need to reduce physical activity, exclude reception alcoholic products, and an hour before the analysis, stop smoking.

A blood test in a child for adrenal hormones, as well as in men, can be taken on any day, women take this test on the 7th day of the menstrual cycle.

How to check the work of the adrenal glands in women? You need to donate blood for androgen. It is this analysis that will help distinguish adrenal diseases from others. women's issues. Normally, the adrenal glands in women should produce 80-560 mcg / dl. You also need to pass the hormone cortisol. The norm of this hormone for an adult (for both men and women) is 150-600 nmol / l.

In order for the picture to be complete, it is necessary to donate blood for the hormone aldosterone, which is important element in the production of both female and male sex hormones. It is taken in the prone position (norm 13-145) and in the standing position (norm 27-270). The “stress resistance” hormone (ACTH) changes its level throughout the day. The morning norm of this hormone should not exceed 25, and in the evening 19 units.

How else can you test adrenal hormones? Saliva tests for the hormone cortisol are considered more accurate than blood tests for the hormones tested. This analysis is called the 24 saliva test. With it, you can determine the work of the adrenal glands in dynamics, since it must be taken 4 times a day. To check the condition of the adrenal glands, a saliva test is done in the morning - high rate, at noon - the level decreases slightly, in the afternoon - the level decreases more noticeably, in the evening - the lowest figure. In some cases, a urine test is ordered.

Instrumental Methods

How to check the adrenal glands with instrumental diagnostics? In order to make a correct diagnosis, one laboratory research not enough. After identifying certain problems based on the results of blood tests of urine and saliva, the doctor may refer the patient to further check the adrenal glands. Diagnostics includes:

Compared to ultrasound, which shows only the size of organs and foreign inclusions, possibly present in them, CT and MRI are much more informative methods. In this case, the diagnosis of the kidney and adrenal glands is carried out in more detail. The procedure can be carried out with contrast agent and without it. Preparation for the procedure is not needed, the only condition is to remove all metal objects, including watches and belts.

Can you test your adrenal glands yourself?

Of course, it is difficult to check their work at home. However, if you have sleep disturbances, nervousness, emotional lability, you have a difficult time with PMS or you have a difficult course of menopause, the following tests can be performed:

Measurement of pressure, this test is called the “Pressure Test”. Lie down for a while at rest, and then measure the pressure. Then get up and immediately measure the pressure again. If the pressure after lifting has increased - this is the norm, but if it turned out to be lower, then one can begin to suspect reduced functionality of the adrenal glands.
Measurement of body temperature. After 3 hours have passed since you woke up, take your temperature and write it down. Then every 3 hours during the day (before you go to bed) measure the temperature and record the data. The next step is to determine the average. Such a test is continued for 5-7 days. After that, the results are summed up. If the average temperature fluctuates by no more than two tenths from day to day, then cortisol levels may be low. If the temperature fluctuations are significant, but it is below normal, then you should probably check the condition of the thyroid gland in addition to the adrenal glands. If the temperature is consistently low, then most likely everything is in order with the adrenal glands, but there may be problems with the thyroid gland. Ideally, the average temperature should be 36.5-36.6 C, there should be no fluctuation from day to day.

The adrenal glands are endocrine system and regulate metabolic processes in the body. These bodies take important role in puberty, maintaining the balance of salts and water. They also support vegetative functions in an active state, participate in biochemical reactions. They play one of the main roles in the correct formation intrauterine fetus and healthy development of the child.

Anatomical and physiological features and functions of the adrenal glands in children

The adrenal glands have an outer cortical layer and an inner medulla. The function of the adrenal cortex is to process biologically active substances(steroids). Their synthesis with cholesterol produces hormones that regulate the body's metabolism. This includes cardiac glycosides - substances that regulate the activity of the heart. The adrenal glands are able to synthesize complex hormonal substances that have no analogues in nature.

The first 10 days after birth, babies are at risk of developing adrenal insufficiency.

A child from the first day of birth to 10 days has a threat of adrenal insufficiency. After this period, the adrenal glands continue to work and develop normally. During the period child development these small organs undergo several stages of change in mass and percentage active substances in the composition. The final formation of the anatomical and physiological features of the adrenal glands ends by about 20 years.

Pathologies and diseases

congenital agenesis, fusion

Agenesis (lack of development) of the adrenal glands almost never occurs, if it does, then the outcome is fatal. Less often, one organ is poorly developed and during life this is not particularly manifested, since another takes over its function. In some cases, fusion (fusion) of the adrenal glands occurs in front of or behind the aorta. Sometimes the adrenal glands are fused with nearby organs - the liver and kidneys. With vices abdominal wall there is a splicing of them with the lungs. Sometimes there may be an abnormal location of the adrenal glands, not in its usual place.

Adrenoleukodystrophy is a hereditary disease that affects the nervous system and adrenal glands.

As hereditary disease isolated adrenoleukodystrophy. As a result, brain nerve cells are damaged at the membrane level. The body is unable to break down the long chain fatty acids. As a result, it is affected nervous system and adrenals. Men are more likely to get sick different ages and the carriers are women. In children from the age of 4, the disease develops rapidly. If such adrenal insufficiency is not identified on early stage, then death is likely in 5-10 years.

Hemorrhage

Hemorrhage in the adrenal glands occurs in premature babies with insufficient vascular density, due to birth injuries, as well as infections, sepsis. Hemorrhage and partial necrosis of tissues lead to the formation of cysts or calcified deposits. If the hemorrhages are extensive and bilateral, then usually everything ends in death. This is due to the developing acute adrenal insufficiency.

Adrenal insufficiency develops when there is a lack of adrenal hormones.

If the adrenal glands sharply reduce the production of hormones or stop their synthesis, acute adrenal insufficiency occurs. Sodium ions and chlorides are lost, the intestines cannot absorb them in full. The body loses fluid, the blood thickens, the violation of circulation ends in shock, the ability of the kidneys to filter decreases. When hormones are produced with a constant deficiency, chronic adrenal hypofunction is formed, it is divided into 3 types:

Congenital adrenal hyperplasia

Congenital disorders of the adrenal glands lead to several clinical pictures. As a result, a decrease in the work of the adrenal cortex blocks the protein and hyperplasia occurs (an increase in the internal number of cells), along with this, the organ grows in volume. The strongest (complete) protein blockade occurs in 3 out of 4 cases, manifests itself immediately after birth. Adrenal insufficiency is formed, androgens (types steroid hormones) are in excess. This leads to the sexual development of girls according to male type, and boys are formed too quickly and have pronounced sexual characteristics from an early age. Other forms have slight manifestation and do not lead to adrenal insufficiency in children. The protein is partially blocked. As a result, girls experience hidden changes in the form of infertility. Very slight violations may not appear at all throughout life.

Primary hyperaldosteronism

The disease is characterized by excessive production of the hormone aldosterone.

Hyperaldosteronism is a disorder of the adrenal glands that results in the production of too much aldosterone. This substance retains sodium and is responsible for the excretion of potassium by the kidneys. Renin regulates blood pressure blood vessels causing them to shrink. This enzyme also regulates sodium and potassium metabolism. An excess of aldosterone produced inhibits the action of renin, which causes an increase in blood pressure, deficiency of magnesium and potassium. Research in this area was conducted by the American scientist Jerome Conn and the pathology is called "Conn's syndrome" or "primary hyperaldosteronism."

Potassium deficiency leads to fatigue muscles, heart attacks, headaches and seizures. The level of calcium also decreases, which leads to numbness of the limbs, cramps, and a feeling of suffocation. Taking potassium and calcium supplements is not prescribed, since there is enough of them in the blood, just unhealthy adrenal glands do not allow them to be well absorbed. Tumors grow in the outer (cortical) layer and in the inner (brain). Are removed surgically supportive treatment is given. An increase in even benign tumors can provoke diabetes mellitus, kidney dysfunction, and a violation of the reproductive system. As a result of the progression of a tumor with metastases, secondary neoplasms occur. The most common among malignant tumors adrenals in children. Its occurrence is assumed due to heredity, the influence of other factors has not yet been determined. The main percentage of the disease occurs in children under the age of 5 years. The third part of cases falls on babies up to a year. And only a small percentage are diagnosed before the age of 10.

Adrenal glands, like others endocrine organs, have great importance for adjustment metabolic processes. This also applies to human sexual development, maintaining the balance of water and salts, generating energy for biochemical reactions and activity of vegetative functions. And they play a very important role for the intrauterine development of the fetus and the formation of the body in newborns.

Structural features of the adrenal glands determines their hormonal work. They consist of medulla and cortical layers, each of which has its own purpose. The regulation of the production of active substances in these organs is regulated by the hypothalamic-pituitary system. The degree of their activity depends on many other factors (stressful situations, nutrition, traumatic injuries body or serious illness).

The adrenal glands begin to form in the fetus in utero at 4-7 weeks, and begin to actively produce hormonal substances already in the second month of the mother's pregnancy. Diseases associated with disruption of the adrenal glands in newborns are congenital and acquired. All congenital variants of diseases, to one degree or another, manifest themselves clinically in a baby after his birth. But he sometimes has acquired pathological conditions. The adrenal cortex has such features of anatomy and physiology that determine the prerequisites for the development of various diseases, it is often found, including in a newborn benign tumor adrenal.

The value of the adrenal glands

During the stay of the fetus in the womb, and in the immediate postpartum period, the adrenal glands help the newborn child to develop and adapt. A special role in this respect belongs to the adrenal cortex, since it comes from a different germ layer, in contrast to the brain part of the organs. Pathological changes the latter are extremely rare in newborns.

Pathologies of the adrenal glands

Violation of the adrenal glands in both adults and newborns, often leads to severe conditions which pose a direct threat to health and life. But with timely detection of problems, there is high probability achieving compensation, and restoring all normal functions in the body.

The most common diseases of the adrenal glands in newborns are as follows:

acute adrenal insufficiency;

congenital insufficiency;

hypercortisolism;

tumors of the adrenal glands (pheochromocytoma).

Acute deficiency

Acute adrenal insufficiency in newborns refers to a very severe form of pathology. The causes of this condition usually become a pronounced hemorrhage in these organs, which is due to:

birth trauma;

asphyxia;

hemorrhagic syndrome in infectious diseases.

Somewhat less often, ONN may occur as a result of congenital hypoplasia, which is transmitted in an autosomal recessive manner, or has an X-linked inheritance. Such a pathology in a newborn can be detected during a genetic study.

Signs of an acute condition

In the case when the adrenal glands practically do not work, the symptoms of the disease in children are manifested as follows:

The baby practically does not move, his pressure and muscle tone drop sharply.

The pulse is noted frequent, shortness of breath develops, the volume of urine excreted decreases.

There is vomiting, diarrhea, different in intensity and location of pain in the intestines. As a result of fluid loss, dehydration can quickly set in, which is a very dangerous condition in a newborn baby.

The temperature drops, the skin becomes pale or cyanotic, sometimes there is a marble pattern, hemorrhages.

AT last stage develops a collaptoid state vascular insufficiency. A decrease in the level of potassium in the blood leads to a stop of the heart muscle.

The rate of development of symptoms in newborns depends on the cause of the insufficiency. With a sharp lesion of the adrenal glands as a result of hemorrhage or the abolition of glucocorticoids, the clinic of the disease develops in a matter of hours. If acute insufficiency is the result chronic process, then the onset of its onset can stretch for several days or months.

Treatment of acute adrenal insufficiency

This condition can quickly lead to the death of a newborn baby, so its treatment is carried out only in the intensive care unit. When providing assistance, parenteral administration of hormones (glucocotricoids and mineralocorticoids) immediately begins. This replacement therapy, if started in time, has an immediate effect and leads to an improvement in the condition of the little patient.

If necessary, anti-shock measures and symptomatic treatment are carried out.

Congenital adrenal hyperplasia

All forms of such a disorder, which manifests itself immediately after birth, are transmitted from parents to children. Most of the hereditary deficiency of 21-hydroxylase. A decrease in the activity of this substance leads to a decrease in the production of cortisol and progesterone. Sometimes a latent form of the disease can develop, in which the secretion of ACTH increases. This leads to an increase in androgen synthesis and activation of the renin-angiotensin system and loss of salts.

Clinical symptoms

There are three main types of adrenogenital syndrome:

viril form;

salt-losing;

erased.

At infants the first two variants of the disease acquire the greatest importance. With the viril form, the visual change of the external genitalia predominates. Girls have an enlarged clitoris and labia. Sometimes hypertrophy is so significant that it is difficult to determine the sex of the newborn. Boys have hyperpigmentation and penis enlargement. Children at birth differ from their peers in thicker bones, increased mass, and more developed muscles.

Salt-wasting variant pathological condition adrenal glands in newborns is most common with adrenogenital syndrome. In this case, there is also virilization of the organs of the genital area, but very dangerous conditions develop in which there is a lack of hormones. The kid often spits up, gains weight poorly, he develops diarrhea and vomiting, body weight and pressure decrease.

Treatment

In this case, only the urgent introduction of hormone replacement therapy in a newborn will help, otherwise the child will a short time may die.

In the presence of latent forms congenital hyperplasia should be used against the background of the diagnosis and determination of the hormonal background required dose oral hormonal drugs that are recommended by the doctor.

Pheochromocytoma

Quite rare, but still found in a newborn tumor of the adrenal gland, which is called pheochromocytoma. In this case, the medulla of these organs is damaged.

Clinically, this manifests itself in the form of an increase in pressure due to an excess of adrenaline and norepinephrine. The child has an increase in heart rate, fever and blood sugar. The hyperexcitability of the baby is striking.

Why are such deviations dangerous?

Diseases of the adrenal glands in children after their birth are fraught with serious consequences. The most dangerous condition is an adrenal crisis, as it can end in the death of a baby in a matter of hours.

For violations related to congenital hyperplasia, there is a loss of fluid and salt in the body, leading to dehydration. Since the nutrition of the baby does not include the use of salty foods, in some cases the disease remains unrecognized for some time, and no measures are taken. In this case, with the urine of a newborn child, there is a constant loss of organs necessary for the functioning, and cardiac arrest may occur.

How to prevent adrenal disease in newborns

In some cases, it is not possible to prevent the development of some pathologies associated with the work of the adrenal glands in young children. Only timely detection of deviations gives a relatively favorable prognosis in this situation.

An adrenal crisis in a newborn can be prevented with timely relief of an increase in the energy expenditure of the child's body during serious illnesses, surgical intervention or injury.

For those babies who are forced to take replacement hormone therapy, it is necessary to draw up a schedule of admission medicines. Parents should give the child drugs strictly in the dosage and time sequence recommended by the pediatric endocrinologist.

For those who are planning a pregnancy and have relatives with abnormalities in the work of the adrenal glands, it is necessary to contact geneticists in advance in order to understand the likelihood of developing a similar pathology in their unborn child, and take all necessary measures.

During the period of gestation, it is recommended that the expectant mother observe the regimen, eat in a timely and rational manner. It is best to avoid stressful situations, walk more often fresh air and move actively. For any disease, immediately seek help from a specialist, and undergo timely treatment.

Dear caring parents! Today we have an article in . And Marina Talanina, mother and doctor by education, invites you to a serious conversation about children's health, namely about the adrenal glands, about what role they play in the body and how to monitor their health.

Adrenal fatigue and child health

Dear readers, in this article we will continue our conversation about the health of our children,. It is very important to do this right now, when very soon the kids will go to kindergartens or schools. And we all know that the full physiology of the child is one of the main factors of his mental well-being, psychological stability and good academic performance.

Today I would like to talk to you about the adrenal glands. It's such small organ, having the shape of a triangle, which is paired and is located directly above the kidneys.

This body has a significant impact on full life child. And in our time, the number of children with the so-called "fatigue" (weakness) of the adrenal glands, which have a huge number of "inexplicable" health problems, has increased. They have a clear imbalance of the whole organism and behavior, and the doctors only "shrug".

Unfortunately, modern doctors in our country do not recognize adrenal disease, and therefore they cannot advise a suffering baby and his mother. However, eminent endocrinologists conducted long-term studies, observing a group of patients with problems with the adrenal glands. The doctors found that the recognized official medicine a disease called "adrenal insufficiency" is preceded by a long period"fatigue" of this body. But, since no one pays attention to the symptoms of such fatigue, then to prevent a formidable illness that can even end lethal outcome, fails.

I won't bore you with complicated medical terms, but I will try to simply explain why health and right job adrenal glands has a significant impact on the physical and mental health the child as a whole. The fact is that in the upper (cortical) layer of the adrenal glands, hormones that are very important for the human body are produced:

cortisol:
adrenaline;
DHEA;
aldosterone;
testosterone.

These hormones:

control the amount of fluid in the body.
affect the level of glucose in the blood;
accelerate the release of calcium into the blood;
affect the process of protein metabolism in the body;
affect the deposition of fat under the skin;
affect immunity;
affect the work of the CCC (cardiovascular system);
affect the condition of the skin muscle mass person;
affect sexual functions;
maintain the water-salt balance in the body;
help conserve energy.

As you can see, any pathology of the adrenal cortex has a very serious effect on the metabolism (metabolism) of the child, and, therefore, on his health in general, since the most important vital processes of the body that ensure its full existence are affected. Let's talk about this in more detail.

Signs that your child's adrenal glands are not working properly:

Physiological:

special sensitivity of the eyes to sunlight. Very often such children cannot walk without sunglasses. However, if possible, spend time in the sun without eye protection. This, just, also helps to strengthen the adrenal glands;
candidiasis - ask your baby to stick out the tongue. If it is covered with a white coating, then the child's body is affected by "thrush". fungal infection can lead to very backfire, to put it mildly. However, this topic deserves a separate article, where we will talk about candida in more detail;
causeless frequent headache;
sleep disturbances - the problem of falling asleep in the evening and waking up in the morning. The child may also wake up frequently during the night;
increased excitability;
excessive fearfulness - too strong shudders with a sharp unexpected sound;
dizziness when getting out of bed;
general lethargy, a tendency to faint;
tendency to allergic reactions;
sleepiness during the day;
low blood pressure;
autoimmune diseases (when a person's immunity begins to work against his own body);
fluid retention in the body;
vomiting for no reason;
pale lips;
sunken cheeks;
always dilated pupils (even when reacting to bright light, they constrict for a short time, after which they expand again);
the presence of many vertical lines on the fingertips;
incomprehensible pains in the knees and joints without any defect in them;
muscle weakness. You may have noticed that the bodies of babies are different from each other. In some children, the skin is tightened and elastic, while in others it is loose and sagging. When probing, you can feel that instead of muscles there is just “jelly”, even if the child plays sports. Children with muscle weakness for a very long time it is not possible to learn how to swing on a swing on their own. They also don't like scooters. The reason is that all this vigorous activity requires long voltage certain muscle groups. That's what happened to my son when he was a toddler. Even after connecting several multidirectional sports sections, the situation has not improved. The muscles didn't want to get stronger. And only targeted efforts to strengthen the adrenal cortex along with physical activity on all muscle groups brought the desired results.

Psychological:

irritability and capriciousness;
depression and depression;
tearfulness;
increased vulnerability and resentment;
strong long-term feelings about some people or events.

Causes of Adrenal Fatigue:

hereditary factor;
weakness of the adrenal glands in the mother during pregnancy;
pathology of intrauterine development;
malfunction of the liver due to toxic lesions(toxins from food, drugs, water and air, especially mercury and other heavy metals);
the presence in the body of hormones contained in store-bought meat products;
stress;
lack of sleep;
infections;
lack of love;
excessive physical activity;
excessive consumption of sugar flour products, various sweets, overcooked foods, trans fats (margarine and fake butter);
lack of vitamins group B, C, A, E;
dysbacteriosis - the predominance of unhealthy microflora in the intestines of a child.

As you can see, our whole life is now conducive to having problems with the adrenal glands. Even adults don't always cope with stress. modern world what to say about the body of the baby. That is why now you can observe so many children with the symptoms described in this article. With such children it is difficult for us, parents, teachers in schools, it is difficult for them with themselves. However, our task is to see the problem in time and help our children put their bodies in order, providing them with a healthy, fulfilling future and a successful life afterwards. After all, the problem will not go away. This is a disease, and not “such a character”, as many people say and think, faced with the fact that they cannot cope with their own child, and simply do not know what to do to raise him.

How to prevent?

So, what should we do in order to correct the problem in the very early age and avoid more serious consequences? Of course, it will take time and some effort, but it's worth it. It is necessary to provide the child with the following conditions:

good rest - sleep no later than 22:30 and at least 8 hours;
proper nutrition - completely exclude from the diet foods that you are allergic to, as well as white sugar, eat less flour and sweets;

regular intake of ALL B vitamins (individually, some of them do not work), vitamin C, A, E in sufficient quantities;
regular intake of magnesium - this microelement produces cellular energy and relaxes the constantly tense muscles of children with exhausted adrenal glands;
regular intake of good probiotics to eliminate intestinal dysbiosis;

Introduction to the child's body enough trace elements is very important, since children with impaired metabolism have their total deficiency. To be sure of this and to know what and how much to inject, you need to give your baby's hair for analysis. The hair test is very informative and will allow you to be confident in your actions.

regular intake of manganese (pineapples and oatmeal are especially rich in them);
regular intake of chromium (regulates blood sugar levels, many children with depleted adrenal glands have problems with sugar content);
daily intake a large number water depending on the age and weight of the child;

Of course, it is very useful for babies with impaired metabolism to drink plenty of water. But first you need to know if the amount of sodium in the body is sufficient for the cell to absorb it. After all, this process directly depends on the amount of sodium. If the hair test shows that it is not enough, then the water will dilute the sodium in the blood even more, and you may feel worse.

regularly drinking salted water (1 cup) with half a teaspoon of salt, or eating something salty with water to restore both the amount of sodium and water in the body;
maintaining sodium-potassium balance;
regular intake of licorice root (licorice) - can be in the form of tea or capsules. Over time, as the adrenal glands become stronger, the dose of licorice consumption should be reduced;
regular intake of amino acids in liquid form;
maintaining the process of digestion of food at the proper level with the help of enzymes. When we talked about children with poor appetite, then the article mentioned the insufficiency digestive enzymes. So, this is also one of the consequences bad work adrenal glands. These children often also have low acidity;
regular intake of essential fatty acids. They are essential for the health of children. Our body cannot produce them on its own, and many babies do not like fish. In addition, not everywhere now you can find high-quality fish, which has become a special rarity in middle lane our country;
the use of natural meat, eggs and dairy products. It is better not to buy these products in supermarkets, but, if possible, take them from the owners you trust. It will be useful to replace regular milk with coconut milk, as it normalizes metabolism very well;
the use of cereals from flaxseed;
eating unrefined food sea salt, instead of the usual one. She is very pleasant in taste. Such salt can be bought in supermarkets in the departments of healthy food.

However, you should carefully look at your child. In some children, on the contrary, the rhythm of cortisol production is often knocked down: it sometimes rises, then drops again. In this case, it is no longer necessary to raise it.

Signs of high cortisol:

vascular pattern on the body of a child (translucent vessels, since cortisol affects vascular tone);
stomach ulcer;
autism;
high blood pressure;
heart disease;
fragility of bones;
lethargy during the day;
frequent colds;
insomnia.

If your child has this condition, then you should consult a doctor and conduct necessary research to understand your actions. The main tool in the correction of this condition is the intake of high doses of vitamin C, which is very necessary for the adrenal glands. The doctor will help determine the amount of intake and the form of this wonderful vitamin.

“How long does it take to restore the adrenal glands?” - you ask. It depends on the degree of their "fatigue":

minor fatigue recovers in about 6 to 9 months;
medium - 12 - 18 months;
severe fatigue can be recovered in up to 24 months.

As you can see, hard work awaits you. It is worth being patient, making a plan and purposefully acting towards restoring the health of your child. After all, the happy, healthy and fulfilling future of our children depends on us, parents.

Marina Talanina,