So what is adrenal insufficiency?

Adrenal insufficiency is an endocrine, or hormonal, disorder that occurs when the adrenal glands do not produce enough of certain hormones. The adrenal glands are located just above the kidneys.
Adrenal insufficiency can be primary or secondary.

Cody has Secondary adrenal insufficiency.

Secondary adrenal insufficiency occurs when the pituitary gland—a pea-sized gland at the base of the brain—fails to produce enough adrenocorticotropin (ACTH), a hormone that stimulates the adrenal glands to produce the hormone cortisol. If ACTH output is too low, cortisol production drops. Eventually, the adrenal glands can shrink due to lack of ACTH stimulation. Secondary adrenal insufficiency is much more common than Addison’s disease.

What do adrenal hormones do?

Adrenal hormones, such as cortisol and aldosterone, play key roles in the functioning of the human body, such as regulating blood pressure; metabolism, the way the body uses digested food for energy; and the body’s response to stress. In addition, the body uses the adrenal hormone dehydroepiandrosterone (DHEA) to make androgens and estrogens, the male and female sex hormones.

Cortisol

Cortisol belongs to the class of hormones called glucocorticoids, which affect almost every organ and tissue in the body. Cortisol's most important job is to help the body respond to stress. Among its many tasks, cortisol helps

• maintain blood pressure and heart and blood vessel function
• slow the immune system’s inflammatory response—how the body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful
• regulate metabolism

The amount of cortisol produced by the adrenal glands is precisely balanced. Like many other hormones, cortisol is regulated by the hypothalamus, which is a part of the brain, and the pituitary gland. First, the hypothalamus releases a “trigger” hormone called corticotropin-releasing hormone (CRH), which signals the pituitary gland to send out ACTH. ACTH stimulates the adrenal glands to produce cortisol. Cortisol then signals back to both the pituitary gland and hypothalamus to decrease these trigger hormones.

This happens all day every day by a normal person day over day except in the case of my son.  His body doesn't produce any Cortisol so we have to manually dose him in accordance to some guideline.

What are the symptoms of adrenal insufficiency and adrenal crisis?

Adrenal Insufficiency

The most common symptoms of adrenal insufficiency are

• chronic, or long lasting, fatigue
• muscle weakness
• loss of appetite
• weight loss
• abdominal pain

Other symptoms of adrenal insufficiency can include

• nausea
• vomiting
• diarrhea
• low blood pressure that drops further when a person stands up, causing dizziness or fainting
• irritability and depression
• craving salty foods
• hypoglycemia, or low blood sugar
• headache
• sweating
• irregular or absent menstrual periods
• in women, loss of interest in sex

Adrenal Crisis

Sudden, severe worsening of adrenal insufficiency symptoms is called adrenal crisis. In most cases, symptoms of adrenal insufficiency become serious enough that people seek medical treatment before an adrenal crisis occurs. However, sometimes symptoms appear for the first time during an adrenal crisis.
Symptoms of adrenal crisis include

• sudden, severe pain in the lower back, abdomen, or legs
• severe vomiting and diarrhea
• dehydration
• low blood pressure
• loss of consciousness

If not treated, an adrenal crisis can cause death.

Some days are good.

Sunday was one of those good days.  We have been working closely to the doctor to figure out how to properly dose Cody for his days of heavy activity or heavy stress.  As I have discussed stress can be good and bad stress.  Stress as adults is easy to see.  Too many medical bills, tough day with work or a coworker with a bad attitude, a broken down car, or a child who is sick.  As a child stress is harder to find.   What child has over extend extended themselves on bills or a broken down car?  None of them do so how do we manage stress.  We have to look at what might or might not be too exciting or stressful in his life. 

This past weekend we “tested” the theory that we have been working through with the doctor.  It’s a theory because every child with AI is different and we are just trying to figure our child out.   We dose him higher when there are going to be long periods of stress or physical activity.  For this weekend he had a scrimmage with his baseball team.  It was close to a game and we “scrimmaged” for almost 3 hours.  He did very well on his new dosing scheme.  He was energetic throughout and came home almost like a normal kid. 

The good news is we learned to control one game on one day.  Now we hope to be able to extrapolate that out to a plan on how to deal with daily issues.  We still have to figure out unknown days that happen on the fly, but we may be closer to figuring out how to deal with those things for which we can plan.

Next week he has state mandated “MAP” testing at school.  This is going to be a test for him, no pun intended.   These types of high pressure tests can be stressful on any normal child let alone my son who has no control over his stress at all.  We will be adjusting him appropriately for these tests, and I hope it works.

It’s not an answer to all our questions, but rather a possible answer to a question that has no right answer.  At least we had a good day.