Adrenal Disease

　　Adrenal diseases include hyperadrenocorticism, hypoadrenocorticism, adrenal tumors, and other diseases. The specific causes of onset are described as follows.

　　1, Cushing's syndrome can be caused by hypothalamic, pituitary, and adrenal lesions, and in a very few cases, it is caused by ectopic adrenocorticotropic hormone (ACTH) produced by benign or malignant tumors in the lung, bronchus, kidney, islet, thymus, or ovary.

　　2, Aldosterone syndrome is 80% caused by adrenal cortical nodular adenoma, the rest of the cases are bilateral adrenal cortical nodular hyperplasia, and cancer is rare. The adenoma autonomously secretes excessive aldosterone, causing water and electrolyte imbalance, hypertension, hypokalemia, and metabolic alkalosis. The diameter of the adenoma is usually less than 3cm, and microadenoma is only visible under the microscope. Single adenoma accounts for 90%, and the left side is more common; multiple adenomas are often located in the same adrenal gland, and only 2% are bilateral.

　　3, Phenylethanolamine增多症: About 80% to 90% of tumors are located in the adrenal medulla, 90% are unilateral solitary, a few are bilateral or one adrenal medulla tumor coexisting with another adrenal extramedullary tumor. This kind of multiple pheochromocytoma is more common in children and patients with positive family history, and belongs to type II and III of multiple endocrine adenoma disease (MEA). Adrenal extramedullary pheochromocytoma is mainly located in retroperitoneal, anterior to the abdominal aorta, and around the lumbar vertebrae (accounting for about 10% to 15%), other rare locations include renal hilum, upper pole of the kidney, hilum of the liver, between the liver and inferior vena cava, and the autonomic ganglion of the abdomen. Extra-abdominal ones are very rare, but there are also reports of them in the thoracic cavity, intracranial, bladder, and neck. Malignant pheochromocytoma accounts for about 10%.

　　4, The common causes of adrenal insufficiency include adrenal tuberculosis or autoimmune adrenalitis; rare causes include deep fungal infections, immune deficiency, viral infections, malignant tumors, extensive adrenal hemorrhage, surgical resection of the adrenal glands, leukodystrophy, and secondary adrenal insufficiency due to POEMS disease, etc. The most common is long-term use of supraphysiological doses of glucocorticoids, which can also be secondary to hypothalamic-pituitary diseases, such as鞍区 tumors, autoimmune pituitaryitis, trauma, surgical resection, postpartum massive hemorrhage leading to extensive infarction and necrosis of the pituitary, known as Sheehan's syndrome, etc.

　　Adrenal disease can cause male sexual dysfunction, oligospermia, and azoospermia, leading to male infertility. Common types of adrenal disease include hypercortisolism, adrenal insufficiency, and aldosteronism. Hypercortisolism, also known as Cushing's syndrome, is caused by excessive secretion of cortisol hormone by the adrenal cortex. High levels of cortisol in the blood can lead to decreased libido and erectile dysfunction in male patients; some patients may have decreased testosterone levels, atrophy of testicular tissue, spermatogenic disorders, degeneration of interstitial cells, and fibrosis of the seminiferous tubules, ultimately leading to infertility.

　　The clinical manifestations of adrenal disease include weakness and fatigue, weight loss, hyperpigmentation, hypoglycemia, and sexual dysfunction, and the specific manifestations are described as follows.

　　1, Weakness and fatigue: The main symptom in the early stage, the degree of fatigue is proportional to the severity of the disease. In severe cases, patients may be unable to turn over or reach for objects. Severe muscle spasms may also occur, especially in the legs. These muscle lesions may be related to sodium and potassium imbalance at the neuromuscular junction.

　　2, Weight loss: Due to the gastrointestinal dysfunction caused by cortisol deficiency, such as anorexia, nausea and vomiting, abdominal distension, and diarrhea; factors such as reduced fat storage and muscle consumption can lead to weight loss, and progressive significant weight loss may predict an adrenal crisis.

　　3, Hyperpigmentation: Due to the weakened inhibitory feedback of adrenocorticotropic hormone (ACTH), melanocyte stimulating hormone (MSH), and lipotropin (LPH) after the deficiency of cortisol, these hormones are secreted in greater amounts, and ACTH and LPH also contain α and β-MSH structures, so hyperpigmentation occurs in the skin and mucous membranes, especially in areas of friction, palm prints, areolas, scars, etc. Hyperpigmentation is one of the main criteria for distinguishing primary and secondary adrenal insufficiency, and the sudden deepening of pigmentation may predict deterioration of the condition.

　　4, Cardiovascular symptoms: Due to the weakened pressor response to catecholamines, blood pressure decreases, with orthostatic hypotension being the most common. X-ray shows a reduced cardiac shadow, and electrocardiogram shows low voltage, prolonged P-R and Q-T intervals. Patients often have dizziness, blurred vision, and orthostatic syncope.

　　5. Hypoglycemia: Patients have increased sensitivity to endogenous and exogenous insulin, and are prone to hypoglycemia in situations such as hunger, gastrointestinal dysfunction, infection, etc.

　　6. Neurological Symptoms: such as apathy, drowsiness, and even mental disorders.

　　7. Decreased resistance to various stresses such as infection and trauma, which are prone to induce adrenal crisis. Extremely sensitive to anesthetics, sedatives, and hypoglycemic drugs, a small amount can cause coma.

　　8. Sexual Dysfunction: Both male and female patients can have decreased sexual function. The androgen derived from female adrenal glands is related to the maintenance of body hair and libido, so women may have sparse or alopecia underarm and pubic hair, menstrual disorders or amenorrhea, and decreased libido. In the case of autoimmune etiology, there may also be premature failure of ovarian and testicular function.

　　Male patients with adrenal diseases should pay attention to relieve mental stress, reform bad living habits, and have moderate exercise in their daily life. The specific preventive measures are described as follows.

　　1. Relieve Mental Stress:Men should avoid mental stress, as stress can have certain adverse effects on the adrenal glands of men, increasing the chance of illness.

　　2. Reform Bad Living Habits:Men should avoid alcohol, tobacco, and caffeine, as these substances have a significant toxic effect on the adrenal glands. At the same time, they should also avoid eating foods high in fat and fried foods, which can increase the stress on the adrenal glands.

　　3. Eat More Fruits and Vegetables:Eat more fresh fruits and vegetables, especially green leafy vegetables, which is one of the preventive methods for adrenal diseases.

　　4. Moderate Exercise:. Men should have appropriate exercise, which can help stimulate the adrenal function of men.

　　5. Supplementation of Nutrition:The extract of milk can assist liver function, thereby helping to improve adrenal function. Various vitamins can reduce the stress on the adrenal glands.

　　The examination of adrenal diseases includes the determination of plasma adrenocorticotropic hormone, cortisol levels, and CT, and the specific examination methods are described as follows.

　　1. Determination of plasma adrenocorticotropic hormone and its related peptide N-POMC.

　　2. Blood and urine cortisol level determination: The blood and urine cortisol levels and urine 17-hydroxycorticosteroids of most patients are lower than normal, or at the lower limit of normal, so repeated measurements are needed, and plasma cortisol disappears.

　　3. Adrenocorticotropic hormone stimulation test.

　　4. Abdominal flat film and adrenal CT scan.

　　5. X-ray shows the heart shadow to be reduced.

　　6. Electrocardiogram shows low voltage, prolonged P-R and Q-T intervals.

　　7. Neurological examination.

　　8. Urological examination, gynecological examination, and sex hormone examination.

　　Patients with adrenal diseases should drink more milk and consume foods rich in vitamins. Avoid alcohol. The specific dietary precautions are as follows.

　　1. Supplementation of Nutrition:Drink more milk, as milk can assist liver function and thereby help adrenal function. Supplementing nutrients such as vitamin D, B-complex vitamins, vitamin C, and beta-carotene can reduce the stress on the adrenal glands.

　　In addition, some natural herbs are beneficial to the adrenal glands, such as astragalus, which can improve adrenal function and help alleviate stress and tension; chrysanthemum can increase the number of white blood cells and ensure the resistance of tissues to bacterial invasion; ginseng helps the adrenal glands cope with stressful situations.

　　2. Avoid using alcohol:Avoid using alcohol, caffeine, and tobacco, as these substances are highly toxic to the adrenal glands and other glands. Also avoid fat, fried foods, ham, pork, highly processed foods, sodas, sugar, and white wheat flour, as these substances increase the stress on the adrenal glands.

　　3. Eat more fresh fruits and vegetables:Eat more fresh fruits and vegetables, especially green leafy vegetables. Beer yeast, brown rice, legumes, olives, whole grains, etc., are healthy foods that can be added to the diet. Eat deep-sea fish, salmon, mackerel, at least 3 times a week.

　　The main cause of the occurrence of adrenal diseases is emotional injury. Emotional activities should be based on the essence of the five internal organs, but on the other hand, abnormal emotions can affect the function of the five internal organs, especially the Qi activity of the human body, causing disharmony of Yin and Yang, disharmony of Qi and blood, blockage of the meridians and collaterals, dysfunction of the internal organs, and disordered coordination between them, leading to the occurrence of the disease. The ancients summarized it as: anger injures the liver, worry injures the spleen, joy injures the heart, sadness injures the lung, and fear injures the kidney.

　　The disease is caused by the liver failing to reach its full potential, internal retention of Qi and fire, dampness and turbidity blocking, and not being able to be released. The liver and kidney store the internal fire, and the fire follows the meridians of the Chong and Ren Channels to rise, thus causing various symptoms of the disease. People with obesity have more dampness, and because of the excess dampness, they become obese. The eyebrows and pubic hair are coarse and black, and there is an increase in hair. Women with more facial hair are a manifestation of excessive Qi and fire. The occurrence of acne is due to the internal retention of dampness and Qi fire in the liver meridian. Mental symptoms are due to the depression of liver Qi and the inability of Qi and fire to be released externally and retained internally.

　　It is better to treat this disease with pure Chinese medicine, treating both the symptoms and the root cause. The use of traditional Chinese medicine treatment has stable, ideal effects and no side effects, and is not easy to relapse after recovery.

　　Traditional Chinese medicine diagnoses and treats diseases according to the patient's symptoms, formulates treatment plans, controls the condition, relieves symptoms, and allows patients to gradually recover. Patients should pay attention to health care in their daily lives.