Arenal gland problem impacts cortisone levels
DEAR DR. ROACH:
Our 37-year-old daughter has Addison’s disease. We have had some difficulty trying to regulate her electrolytes and her blood pressure, which is always low, sometimes extremely so. She has known about it for 10 years now. What can one do besides try to stay hydrated to keep the pressure up? Last evening, her blood pressure was 95/58 with a pulse of 88. She is on steroids for life.
ANSWER:
Addison’s disease is caused by destruction of the part of the adrenal gland that makes cortisone. This leads to a deficiency of that hormone, which is necessary for the body’s response to stress, and which also is partially involved in salt and water metabolism. Adrenal insufficiency is most often caused by autoimmune disease, but rarely it can be caused by tuberculosis or a hemorrhage into the gland. In some cases, the adrenal gland is normal, and it is the pituitary gland or the hypothalamus in the brain that fails to send the signal that hormone is needed. Cortisone is the steroid most often used for treatment. There are several different families of steroids. Corticosteroids are named after cortisone, which reduces inflammation, increases blood sugar and has complex effects on protein metabolism.
Cortisone also has some min era loc or ti co id effects, which makes the kidney hold on to sodium and lose potassium. (These steroids are completely different from anabolic steroids, like testosterone, which promote bone and muscle growth.) Under periods of high stress — say, surgery or serious illness — people need more cortisone.
A blood pressure of 95/58 is low, but in the normal range for some people. It may have nothing to do with her adrenal insufficiency.
However, the difficulty you report with her electrolytes makes me suspect that she may not be getting enough min era loc or ti co id. Although some people get enough from the cortisone they take, others need to take additional min era loc or ti co id,su chas fludrocortisone.
Dr. Keith Roach is a syndicated columnist based in Florida.