Adrenal glands: Addison's disease

The adrenal glands are responsible for secreting vital hormones that are essential for the body’s ability to function throughout the day. Among a variety of crucial physiological processes, they also allow adaptation and resilience to the usual, inevitable, and unforeseen stressors found within daily life (UCSF, 2018). Adrenal insufficiency, also known as Addison’s disease, is a rare condition of the endocrine system which results in a lack of production of the glucocorticoid - cortisol, and the mineralocorticoid - aldosterone, by the adrenal glands (Corrigan, 2013). The etiology is most commonly classified to be ‘primary’, wherein the gradual destruction of the adrenal cortex has taken place due to an immune mediated response. Yet sometimes a ‘secondary’ cause is discovered, where a lack of Adrenocorticotropic hormone (ACTH) has resulted in a lack of production of the vital hormones (Corrigan, 2013).

Treatment for this condition revolves around substituting or replacing the hormones cortisol and aldosterone that are absent in the body. Daily administration of a synthetic glucocorticoids, cortisone or hydrocortisone, can be taken orally to replace cortisol. Additionally, if aldosterone is deficient, daily oral doses of a mineralocorticoid, fludrocortisone acetate, can be prescribed (Corrigan, 2013). The addition of DHEA (dehydroepiandrosterone) to these prescriptions have been found to greatly reduce cardiovascular risk factors by reducing total cholesterol and LDL cholesterol levels (Hetchman, 2012).

Complementary therapies that can be used to support these allopathic medical treatments should revolve around the clinical markers of disease and addressing the presenting symptoms. Primarily minimizing all environmental, emotional, and dietary stressors is of high importance. The avoidance of any unnecessary and excessive stimulus to the adrenal glands will be allowing the chosen treatments the greatest capacity of therapeutic action. Certain herbal medicines with therapeutic actions of adaptogenic, nervine tonic, and anti-inflammatory should be considered (Hetchman, 2012).

Aldosterone regulates the amount of salt, potassium, and water in the body, indicating that an insufficiency can create potentials of electrolyte imbalance, hypoglycemia, and the progression of the disease as a result. 24-hour urine tests revealing potassium and sodium levels can provide additional markers on the level of care that needs to be offered through lifestyle and nutritional education (Hetchman, 2012).

Interestingly, Glycyrrhetic acid (GL) and glycyrrhetic acid (GA), two active metabolites of Glycyrrhiza glabra (liquorice), have a mineralocorticoid effects in the body, helping to elevate sodium levels, in a manner similar to that of aldosterone. The physiological mechanism of action is the inhibition of 11-ß-HSD, an enzyme that helps regulate glucocorticoid levels through the catabolism and conversion of inert 11 keto-products to active cortisol, whilst additionally suppressing 5-ß reductase activity, inhibiting hepatic metabolism of cortisol (Omar et al., 2012). This has physiological significance as cortisol binds to mineralocorticoid receptors as willingly as aldosterone does. For these reasons however, licorice should not be taken long term, especially in conjunct with other corticosteroid medication, due to its ability to potentiate their effects (Hetchman, 2012). This single example of the anti-inflammatory adrenal tonic, licorice, shows that a professional level of research, with a sufficiently educated degree of phytotherapy needs to be comprehended prior to conducting any conjunct therapies to pre-existing medical treatments.

Reference:

Corrigan, E. K. (2013). Adrenal Insufficiency (Addison’s Disease) | Disorders | Knowledge Base. Retrieved June 25, 2019, from https://pituitary.org/knowledge-base/disorders/adrenal-insuffieciency-addison-s-disease

Omar, H. R., Komarova, I., El-Ghonemi, M., Fathy, A., Rashad, R., Abdelmalak, H. D., … Camporesi, E. M. (2012). Licorice abuse: time to send a warning message. Therapeutic Advances in Endocrinology and Metabolism, 3(4), 125–138. https://doi.org/10.1177/2042018812454322

UCSF. (2018). Adrenal Insufficiency Diagnosis | Conditions & Treatments | UCSF Medical Center. Retrieved June 23, 2019, from https://www.ucsfhealth.org/conditions/adrenal_insufficiency/