describe the primary function of the adrenal glands

Routine treatment is life-long oral hydrocortisone and fludrocortisone teach patients what to do if ill, to carry a steroid emergency card, and to keep injectable hydrocortisone. I've met several patients who were initially refused rescue hydrocortisone because A&E staff thought they were drug abusers! If in doubt give hydrocortisone. If suspected, take blood for a later cortisol test and immediately give intravenous hydrocortisone then 0.9% saline infusion.

An adrenal crisis – severe cortisol lack – can kill. Tests may show low sodium, raised potassium, uraemia, and metabolic acidosis.

Symptoms of Addison's disease include tiredness, weakness, anorexia, weight loss, nausea and vomiting, dizziness, and skin pigmentation. The main cause of adrenal insufficiency in Addison's time, and world-wide today is tuberculosis in the UK autoimmunity is more common adrenal suppression may also persist after medical corticosteroid treatment. Autoimmune damage impairs mineralocorticoid and androgen production too. The teenager in custody with unrecognised hypoglycaemia had not only type 1 diabetes (it is essential for everyone with insulin treated diabetes to carry warning ID) but also hypothyroidism and Addison's disease – lack of adrenal cortisol – conditions linked by autoimmunity.

Glucocorticoid production is controlled by pituitary adrenocorticotrophic hormone (ACTH) pituitary disorders may cause cortisol lack or excess. Cortisol (hydrocortisone) is the main glucocorticoid. Glucocorticoids reduce inflammation, stimulate gluconeogenesis, inhibit muscle glucose uptake, increase fatty acid production, and favour sodium retention and potassium loss. Addison's disease and adrenal insufficiency The medulla produces catecholamines (adrenaline and noradrenaline ) while the cortex produces glucocorticoids (cortisol and cortisone), mineralocorticoids (aldosterone), and androgens. The adrenal glands sit above the kidneys. He had both thyroid and adrenal antibodies. He recovered with hydrocortisone and saline infusion. Synacthen did not stimulate a cortisol rise confirming Addison's disease. Later he was admitted with vomiting, skin pigmentation, vitiligo, hyponatraemia, and hyperkalaemia.

A Synacthen test was unsuccessful he defaulted a repeat. His blood pressure was 98/58 with faint skin pigmentation and normal electrolytes. Glucose balance and clinic attendance were erratic he'd had multiple severe hypos and HbA 1c had fallen from 10.3% to 6.2% despite reducing insulin. His son had both type 1 diabetes and hypothyroidism. The police thought he was abusing drugs until his father arrived and successfully treated the severe hypoglycaemia. In custody he was drowsy, incoherent, and verbally abusive’. A 19-year-old man ‘was detained and charged by the police after driving erratically and dangerously for four miles on the city bypass.

Describe the primary function of the adrenal glands