How do thyroid and adrenal glands interact. What are the symptoms of hypothyroidism and adrenal fatigue. Can thyroid hormone affect adrenal gland development. How is adrenal fatigue diagnosed and treated. What are the risks of adrenal hormone supplements.

The Interconnected World of Thyroid and Adrenal Glands

The human endocrine system is a complex network of glands that work in harmony to maintain our body’s homeostasis. Two key players in this intricate system are the thyroid and adrenal glands. While these glands have distinct functions, their interplay is crucial for optimal health and well-being.

The thyroid gland, located in the lower front of the neck, produces hormones that regulate metabolism, growth, and development. On the other hand, the adrenal glands, situated atop the kidneys, produce hormones like cortisol that help manage stress, regulate blood pressure, and control inflammation.

Can thyroid dysfunction impact adrenal function?

Yes, thyroid dysfunction can indeed affect adrenal function. When the thyroid gland is underactive (hypothyroidism), it can lead to symptoms that closely resemble those of adrenal fatigue. Moreover, people with hypothyroidism often have weak adrenal glands, creating a complex interplay between these two endocrine organs.

Decoding Hypothyroidism: Symptoms and Implications

Hypothyroidism occurs when the thyroid gland fails to produce sufficient thyroid hormones. This condition can have far-reaching effects on various bodily functions.

What are the common symptoms of hypothyroidism?

• Fatigue and weakness
• Cognitive difficulties (forgetfulness, brain fog)
• Depression
• Sensitivity to cold
• Dry skin
• Constipation
• Weight gain

These symptoms can significantly impact a person’s quality of life and may be mistaken for other conditions, including adrenal fatigue.

Adrenal Fatigue: Myth or Reality?

The concept of adrenal fatigue has sparked considerable debate in the medical community. While some healthcare practitioners recognize it as a valid condition, others remain skeptical.

Is adrenal fatigue a recognized medical diagnosis?

According to the Endocrine Society, adrenal fatigue is not an accepted medical diagnosis. The society states that there is no scientific evidence to support the theory that long-term stress depletes the adrenal glands and causes common symptoms associated with adrenal fatigue.

Dr. Singer, an endocrinologist, notes that adrenal fatigue is not taught in medical schools and is not a recognized diagnosis among mainstream medical practitioners.

Why is adrenal fatigue controversial?

The controversy surrounding adrenal fatigue stems from several factors:

1. Lack of scientific evidence supporting its existence as a distinct medical condition
2. Absence of standardized diagnostic criteria
3. Overlap of symptoms with other recognized medical conditions
4. Potential risks associated with unnecessary treatment

Despite the controversy, many individuals report experiencing symptoms commonly attributed to adrenal fatigue, leading some healthcare providers to explore alternative approaches to address these concerns.

The Thyroid-Adrenal Connection: New Scientific Insights

Recent research has shed light on the intricate relationship between thyroid function and adrenal gland development. A groundbreaking study by Huang et al. has revealed a direct role for thyroid hormone in the development of the adrenal cortex.

How does thyroid hormone influence adrenal gland development?

The study discovered that thyroid hormone, acting through one of its receptor isoforms (THRB1), plays a crucial role in adrenocortical development and function. This finding establishes a direct link between thyroid hormone and adrenal gland development, challenging previous understanding of the relationship between these two endocrine organs.

What are the implications of this discovery?

This new insight into the thyroid-adrenal connection has several important implications:

• It provides a potential explanation for the observed relationship between thyroid and adrenal dysfunction in certain autoimmune conditions
• It may lead to new approaches in diagnosing and treating combined thyroid and adrenal disorders
• It underscores the importance of considering both thyroid and adrenal function when evaluating endocrine health
• It opens up new avenues for research into the developmental biology of endocrine glands

Diagnosing and Addressing Adrenal Concerns

While adrenal fatigue remains a controversial topic, individuals experiencing persistent fatigue and other symptoms associated with adrenal dysfunction may seek evaluation and treatment.

How are adrenal concerns typically evaluated?

Evaluation of adrenal concerns typically involves:

1. Comprehensive medical history and symptom assessment
2. Physical examination
3. Blood tests to measure hormone levels, including cortisol
4. Evaluation of thyroid function
5. Screening for other potential causes of fatigue and related symptoms

It’s important to note that there is no specific test for adrenal fatigue. Diagnosis often relies on a combination of clinical signs, symptoms, and laboratory findings.

What approaches are used to address adrenal concerns?

Treatment approaches for individuals experiencing symptoms associated with adrenal fatigue may include:

• Lifestyle modifications (stress reduction, improved sleep habits, balanced nutrition)
• Relaxation techniques (meditation, deep breathing exercises)
• Dietary changes (reducing high-fructose corn syrup, gluten, and caffeine intake)
• Nutritional supplements (under medical supervision)
• Addressing underlying health conditions

It’s crucial to work with a healthcare provider to develop an appropriate treatment plan tailored to individual needs and circumstances.

The Controversial World of Adrenal Supplements

The use of adrenal hormone supplements to address symptoms associated with adrenal fatigue is a topic of debate within the medical community.

Are adrenal hormone supplements safe?

Many endocrinologists caution against the use of adrenal hormone supplements, particularly when there is no clear medical need. Dr. Singer warns that taking these supplements unnecessarily could potentially cause the adrenal glands to stop working properly.

What are the risks associated with adrenal hormone supplements?

Potential risks of using adrenal hormone supplements include:

• Suppression of natural adrenal hormone production
• Imbalance of other hormones in the body
• Increased vulnerability to stress
• Risk of adrenal crisis, a life-threatening condition
• Interactions with other medications

Given these potential risks, it’s crucial to consult with a healthcare provider before considering any adrenal hormone supplements.

Navigating the Complexities of Thyroid and Adrenal Health

The relationship between thyroid and adrenal function is complex and multifaceted. While scientific understanding of this relationship continues to evolve, individuals experiencing symptoms related to thyroid or adrenal dysfunction should seek comprehensive medical evaluation.

How can individuals optimize their thyroid and adrenal health?

Strategies for supporting thyroid and adrenal health include:

1. Maintaining a balanced, nutrient-rich diet
2. Engaging in regular physical activity
3. Managing stress through relaxation techniques and lifestyle modifications
4. Ensuring adequate sleep and rest
5. Avoiding exposure to environmental toxins
6. Regular medical check-ups and appropriate screening tests
7. Working closely with healthcare providers to address any hormonal imbalances

By adopting a holistic approach to endocrine health, individuals can support the optimal function of both their thyroid and adrenal glands, promoting overall well-being and vitality.

Future Directions in Thyroid and Adrenal Research

The field of endocrinology continues to evolve, with ongoing research shedding new light on the intricate relationships between various endocrine glands.

What are some promising areas of research in thyroid and adrenal health?

Emerging areas of research include:

• Further exploration of the molecular mechanisms underlying thyroid-adrenal interactions
• Development of more sensitive and specific diagnostic tools for adrenal dysfunction
• Investigation of the impact of environmental factors on endocrine health
• Exploration of personalized treatment approaches based on individual genetic and hormonal profiles
• Research into the role of the gut microbiome in thyroid and adrenal function

As our understanding of the endocrine system deepens, it is likely that new approaches to diagnosing and treating thyroid and adrenal disorders will emerge, offering hope for improved outcomes for individuals affected by these conditions.

In conclusion, the relationship between thyroid and adrenal function is a complex and fascinating area of endocrinology. While controversies persist around concepts like adrenal fatigue, ongoing research continues to reveal new insights into the interconnected nature of these vital endocrine glands. By staying informed about the latest developments in this field and working closely with healthcare providers, individuals can take proactive steps to support their thyroid and adrenal health, promoting overall well-being and vitality.

Hypothyroidism and Adrenal Fatigue | Everyday Health

Hypothyroidism and Adrenal Gland Troubles

The thyroid is another gland responsible for producing hormones that keep your body running optimally. When the thyroid gland, which is in the lower front of your neck, isn’t functioning well, you can become tired, forgetful, and depressed — similar to adrenal symptoms. Other signs of hypothyroidism include feeling cold, dry skin, and constipation.

Because some of the symptoms of hypothyroidism are similar to adrenal fatigue, the two conditions can be confused, Borenstein says. In addition, people with hypothyroidism often have weak adrenal glands, he adds. The two glands work together to supply essential hormones and deliver them where they need to be throughout the body. When your adrenal glands aren’t producing enough cortisol and you have a thyroid problem, it can make the situation much worse, Borenstein says.

Controversy Around Adrenal Fatigue

Adrenal fatigue is somewhat of a controversial topic. According to the Endocrine Society, adrenal fatigue is a myth promoted by health books and alternative medicine websites. “There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms,” the society says on the Hormone Health Network website.

“Adrenal fatigue isn’t an accepted diagnosis,” Dr. Singer says. “It’s not something doctors are taught about in medical school.”

However, if you take synthetic hormones for hypothyroidism and still experience fatigue and other symptoms, it’s important to determine the cause, Singer says. Extreme fatigue can be a symptom of many health other conditions, such as depression, that are identifiable and treatable, he says.

There’s no test for adrenal fatigue, according to the Endocrine Society. However, if your traditional doctor believes your synthetic thyroid hormone should be making you feel better and it’s not, you can schedule an appointment with a doctor that practices alternative or integrative medicine if you’re interested in learning more about adrenal fatigue.

If Borenstein suspects adrenal fatigue, his first recommendation is to practice relaxation techniques like meditation and deep breathing. He also recommends cutting back on high-fructose corn syrup, gluten, and stimulants (such as caffeine) and to get good sleep.

Treating Adrenal Fatigue

If making these types of lifestyle changes don’t help improve your symptoms, you can take supplements to build your adrenal glands back up, Borenstein says.

However, many endocrinologists warn that taking adrenal hormone supplements when you don’t need them is dangerous. “These hormone supplements could cause your adrenal glands to stop working,” Singer says. The glands could become unable to make the hormones you need when you’re under physical stress, he says, and you could be in danger of going into adrenal crisis, a life-threatening condition.

Before taking any supplements, be sure to talk to your doctor and undergo any testing to rule out other possible causes of your symptoms.

A Direct Role for Thyroid Hormone in Development of the Adrenal Cortex

A relationship between thyroid and adrenal dysfunction has been recognized for some time. Certain human autoimmune conditions, for example, can destroy both the thyroid gland and adrenal cortex resulting in combined hormone deficiencies. Beyond autoimmune destruction, however, a relationship between thyroid and adrenocortical function is less clear. Glucocorticoid excess has been shown to suppress the central thyroid axis, whereas thyroid hormone has been suggested to regulate adrenocortical function through changes in hepatic glucocorticoid metabolism. Overall, these studies are limited in scope, and any real regulatory relationship between these glands still remains tenuous (Samuels and McDaniel [1], Johnson et al [2]). This is why the study of Huang et al (3) is both timely and novel. These investigators show for the first time that thyroid hormone, acting through one of its receptor isoforms (THRB1), has a direct role in adrenocortical development and function.

The adrenal cortex in mammals develops from intermediate mesoderm, whereas the adrenal medulla is derived from neuroectoderm (neural crest cells). The adrenal cortex first forms an immature zone, which is later replaced by mature cortical cell types. The immature or fetal zone in humans produces dehydroepiandrosterone sulfate, which is used by the placenta to produce estrogens. The definitive or adult zone in humans and other mammals, in contrast, produces mineralocorticoids and glucocorticoids.

In immature mice, an inner cortical zone has been described that expresses the steroid-metabolizing enzyme, 20-α-hydroxysteroid dehydrogenase (20αHSD). This is termed the x-zone and regresses in male but persists in female adult mice. Whether there is a developmental equivalent of this zone in higher mammals is unclear at the present time. Interestingly, gonadal factors, gonadotrophins, and thyroid hormone are known to modify the appearance of this zone (Huang et al). Huang et al show, using a β-galactosidase tagged Thrb1 locus, that THRB1 colocalizes with 20αHSD to the x-zone in mice. In addition, they demonstrate that T₃ treatment causes hypertrophy of this zone in wild-type but not Thrb^−/− mice. As the authors point out, thyroid extract has also been reported to induce hypertrophy of the adrenal cortex in other species, such as the rabbit and cat, that lack a definable x-zone, which suggests that this finding might be generalizable to other mammals including humans.

Armed with this knowledge, one might now wonder whether thyroid hormone deficiency per se can cause subtle or overt adrenocortical hormone deficiency by acting directly on the gland. The challenge here is to understand more fully the role of the fetal zone, which includes the x-zone, in adult adrenal cortical function. It appears that the definitive adult cortex develops from surface capsular cells that migrate into the gland, but the authors suggest that the x-zone might represent another source of cells involved in the stress response. Unfortunately, this hypothesis was not tested further in their study. One might predict, for instance, that hypothyroidism limits the acute stress response to ACTH or that thyroid hormone excess increases steroid hormone levels by expanding residual x-zone cells in the adult animal. Alternatively, the authors propose that thyroid hormone might regulate progesterone and 11-deoxycorticosterone levels via 20αHSD, which is known to catabolize both hormones, and this might alter adrenal function in some unknown way. Finally, given that thyroid hormone regulates adrenocortical cell development, it might also change cell surface antigens and be involved in some way in inducing adrenocortical autoimmunity. More work will need to be done to answer these questions.

A clear role for thyroid hormone receptors in the development of the cerebellum, retina, and cochlea has been shown using Thrb^−/− mice (Ortiga-Carvalho et al [4]), and many of these studies have been performed by the Forrest group. This study extends our knowledge of thyroid hormone to development of the adrenal cortex and provides a potential mechanism to explain unrecognized adrenocortical hormone deficiency in models of congenital hypothyroidism and adrenocortical hormone excess in states of thyroid hormone excess.

Thyroid and Adrenal Balance | Restorative Medicine

Understanding the Adrenal and Thyroid Connection – by the Holtorf Medical Group
Everything you need to know about the relationship between low thyroid and adrenal problems.

Are you always tired, no matter how much sleep you get? Do you feel like your brain is in a fog? Are you cold when others aren’t? Do you find that you can’t lose or keep weight off despite dieting? You may be suffering from a thyroid deficiency, or hypothyroidism. Your thyroid gland is like your body’s gas pedal. When it’s cruising at the right speed, you feel great. But when it’s not “giving enough gas” – or not producing enough thyroid hormone – you feel like you’re driving in slow motion with one foot on the brake pedal.

But many hypothyroid symptoms are so similar to adrenal fatigue that the two are often confused or misdiagnosed.

On top of this confusion, tests for thyroid and adrenal problems are often difficult to interpret correctly. Some doctors believe that even if you had low thyroid function, it could be adrenal stress causing the problem to begin with.

What Role Do The Adrenal Glands Have With Proper Thyroid Function?

The adrenals are your “life saving” organs because they control your body’s hormones and help you survive in stressful situations. They act as control organs for your “fight or flight” response and secrete many of our most important hormones including: pregnenolone, adrenaline, estrogen, progesterone, testosterone, DHEA and cortisol.

When your adrenals are constantly stressed, this sets off an autoimmune, inflammatory response in your entire body. The adrenal-hypothalamus-pituitary feedback loop regulates the secretion of cortisol. All of your organs and your immunity are impacted negatively by the resulting constant assault of cortisol. Low adrenal function can actually cause someone’s thyroid problem to be much worse than it would be otherwise.

Which Are The Symptoms Of A Low Thyroid?

The thyroid is located below your Adam’s apple at the front of your neck. Thyroid disorders can affect your sense of well-being, metabolism and ability to ward off viruses and bacteria. Many people experience a constellation of symptoms and signs suggestive of an underactive thyroid gland and/or adrenal dysfunction. Some of the most common symptoms include: fatigue, weight gain, depression, sensitivity to cold, muscle or joint aches, brain fog, poor memory, brittle hair and nails, shortness of breath, thinning hair, PMS, significantly calloused heels, chronic yeast infections, low libido, infertility.

If low-thyroid people with these symptoms are put on thyroid hormone alone, they sometimes respond negatively. These people may have coexistent, but hidden, low adrenal levels. If they take thyroid hormone by itself, the resultant increased metabolism may accelerate the low adrenal problem.

Also, interactions between the hormones are sometimes as important as the direct action of the hormone itself. Some adrenal hormones assist in the conversion of T-4 to T-3, and perhaps assist in the final effect of T-3 on the tissues. Some scientists believe that even the entrance of thyroid hormone into the cells is under the influence of adrenal hormones. Thus, if your adrenal level is low enough, you might do well to take both adrenal and thyroid hormone together. Ultimately, this delicate balance should be only established by your expert in bioidentical hormone therapy, considering the right interpretation of your test results.

Testing And Treatment Of Thyroid Disorders

Reality is that many conventional medical doctors use an outdated reference range to evaluate thyroid function.Thyroid deficiency is extremely common but goes undetected by standard thyroid tests. Standard testing does not pick up 80% of patients who have low thyroid!

Studies have demonstrated that standard thyroid tests do not correlate with tissue levels of thyroid and so they provide inaccurate diagnosing. Most physicians and endocrinologists incorrectly feel the TSH is the best indicator of the thyroid status of an individual. They fail to understand that a person may suffer from significantly low thyroid despite having a normal TSH, free T3 and free T4.

Even when a patient is diagnosed with hypothyroidism, most doctors treat the disorder improperly or suboptimally with T4-only medications such as Synthroid, Levoxyl, or Levothyroxine. This treatment can cause the patient’s lab results to look “normal” while the patient still feels exhausted or cannot lose weight.

Experts at Holtorf Medical Group specialize in comprehensive testing, including Free T4, Free T3, reverse T3, sex hormone binding globulin (SHGB), leptin, computerized measurement if tissue thyroid levels, and basal metabolic rate. The treatment options are efficient and include customized bioidentical thyroid hormone combinations of T4/T3, as well as time-released T3 and important nutritional supplements that can help regulate thyroid balance, support a healthy metabolism, and improve weight loss, energy and mood.

– Holtorf Medical Group

Is It Your Thyroid Or Adrenal Fatigue?

Your body is talking to you, but you’re not sure how to interpret the message: You’re inexplicably tired all the time, you can’t concentrate, and you’re crankier than usual. Your skin is also dry, your hair seems to be thinning, and you’re gaining weight. What’s going on? 

A quick consult with doctor Google will point you toward a number of possible diagnoses, with hypothyroidism and adrenal fatigue likely topping the list. The only way to get to the root of your problem is to see a real live MD, who ought to take a thorough history, do a physical, and perhaps run a few tests. In the meantime, here’s some insight into whether a thyroid or adrenal issue might be to blame.

Think thyroid first.

SCIEPRO/getty images

Thyroid disorders are extremely common, says Antonio Bianco, MD, PhD, professor of internal medicine at Rush University Medical Center and president of the American Thyroid Association. He notes that 11 million people in the US have an underactive thyroid (aka hypothyroidism). Women are more likely than men to develop this problem; the risk also goes up after age 60.  

When your thyroid—a small, butterfly-shaped gland that sits at the base of your neck—is functioning properly, it produces hormones that regulate your metabolism and body temperature. If it’s not making enough thyroid hormone, your body’s processes start slowing down. At first, you may not notice anything. But as your metabolism continues to slow, the classic signs of a sluggish thyroid kick in: fatigue, weight gain, constipation, sensitivity to cold, and dry skin. (Here’s how you can get those fat-loss hormones in check using Prevention’s The Hormone Fix.) 

Of course, these symptoms can point to other conditions as well, so the only way to be certain you have hypothyroidism is with a TSH (thyroid-stimulating hormone) blood test. “If TSH is high, you have hypothyroidism—simple as that,” says Bianco. Your doc will likely prescribe a daily dose of a synthetic thyroid hormone (thyroxine) to replace what your body is missing. 

MORE: 16 Signs Your Thyroid Is Out Of Whack

All about your adrenals

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If your thyroid checks out, then maybe it’s time to consider adrenal fatigue.  

It’s worth noting that most mainstream physicians don’t think adrenal fatigue exists. But some health care practitioners—mostly naturopathic doctors and some holistic MDs—believe that adrenal fatigue is real and ought to be taken seriously. (Here are 7 other possible reasons you’re tired all the time.) 

According to the believers, signs of adrenal fatigue include being both tired and wired, getting lightheaded when you stand up quickly, not being able to shake colds or infections, and feeling anxious, irritable, or moody. The theory is that these symptoms occur because your adrenals—tiny glands that sit on top of your kidneys and secrete stress hormones—burn out. The result is a mild form of cortisol deficiency, which may be called adrenal fatigue or adrenal dysregulation. (This should not be confused with adrenal insufficiency or Addison’s disease.)

Adrenal fatigue happens when “unremitting stress causes your adrenals to pump out more and more stress hormones, and after working overtime for too long, they can’t keep up,” says Sara Gottfried, MD, author of The Hormone Reset Diet. “The adrenal glands sputter, cortisol levels drop, and you feel depleted.”

If you think you might have this issue, Gottfried recommends getting your cortisol levels tested. Cortisol can be measured with blood, urine, saliva, or even hair tests, says Gottfried. “Most [Western] doctors only recognize the merits of blood testing—it’s considered the universal language of conventional medicine,” says Gottfried—but she believes that dried urine testing (it involves peeing on a piece of filter paper) may be a better option for measuring hormones. 

MORE: 10 Silent Signals You’re Stressed

Gottfried says it’s smart to consider adrenal fatigue a possibility in a number of cases. “Sometimes it’s felt as anxiety, depression, or PMS,” she says. “Other times, adrenal dysregulation may occur in perimenopause and menopause with worsening hot flashes, night sweats, difficulty sleeping, and low sex drive. When these problems are addressed without consideration of adrenal function, symptom improvement is short-lived or never achieved. ” She suggests keeping a log of your symptoms that you can share with your healthcare provider. 

If you are diagnosed with adrenal fatigue, lifestyle changes might do the trick. Gottfried says you should cut out sugar (“It acts as an adrenal stimulant”), as well as boost your intake of key vitamins that support this gland, including B vitamins and vitamin C. 

Exercise is also important, but make like Goldilocks: “When your adrenals are stressed, you need to be careful not to underdo it or overdo it,” says Gottfried. A 20-minute walk or light jog might be plenty while you’re healing. 

Meanwhile, limit your exposure to toxins, such as bisphenol A (BPA), which can mess with your hormones. You’ll find BPA in certain plastic containers, many canned goods (cans are often lined with BPA), and on credit card receipts. 

Some practitioners also give cortisol to patients with adrenal fatigue, but this is controversial, as taking too much of this hormone can be dangerous.

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Hypothyroidism and Adrenal Insufficiency in Sepsis and Hemorrhagic Shock | Critical Care Medicine | JAMA Surgery

Hypothesis 
We hypothesized that hypothyroidism and adrenal insufficiency frequently occur together in critically ill patients.

Design 
A prospective observational study.

Setting 
Surgical intensive care unit of a university-affiliated tertiary referral center.

Patients 
Sixty-six consecutive patients with severe sepsis, septic shock, and hemorrhagic shock who required pulmonary artery catheterization for resuscitation were studied.

Interventions 
Thyrotropin and baseline cortisol levels were obtained at 3 AM followed by intravenous injection of 250 μg of cosyntropin, a synthetic adrenocorticotropic hormone derivative. A second measurement of the cortisol level was performed 1 hour later.

Main Outcome Measures 
Incidence of hypothyroidism and adrenal insufficiency and mortality.

Results 
Mean (SD) age was 62 (19) years. The mean (SD) Acute Physiology and Chronic Health Evaluation II score was 21 (5). Twenty-seven patients (40.9%) had severe sepsis, 31 (46.9%) had septic shock, and 8 (12.1%) had hemorrhagic shock. Five patients (7.6%) had hypothyroidism alone and 35 (53.0%) had only adrenal insufficiency. Eight patients (12.1%) had both hypothyroidism and adrenal insufficiency. All patients with endocrine abnormalities were treated. Mortality for the total group was 15 (22.7%) of 66 patients.

Conclusion 
There is a 12% incidence of simultaneous hypothyroidism and adrenal insufficiency in our study and the routine testing for both may be indicated in this population of critically ill patients.

Multiple endocrine derangements have been described in critically ill patients. These include abnormalities in the levels of thyroid,^1-3 adrenocortical,⁴ growth,⁵ and sex hormones.⁶ The clinical significance of various changes in the thyroid hormone levels and the appropriateness of endocrine intervention is controversial.^7-9 Maldonado et al¹⁰ showed that a high level of thyrotropin (TSH) is a significant independent predictor of nonsurvival in critically ill patients. Subclinical hypothyroidism, defined as increased TSH concentrations associated with normal free thyroxine (T₄) and free triiodothyronine (T₃) concentrations, have been shown to have significant negative effects on cardiac function^11,12 that are reversible when euthyroidism is restored.¹²

Adrenal insufficiency can be caused by sepsis, surgery, bleeding, and head trauma. In a recent study Zaloga and Marik⁴ have reported incidences of adrenal insufficiency in critically ill patients ranging from 0% to 95%. This wide range, in part, results from a lack of a standard definition of adrenal insufficiency. Some of the definitions used by different investigators are as follows: (1) maximal cortisol concentration less than 18.0 to 20 μg/dL after a 250-μg dose of cosyntropin,^13,14 (2) change in cortisol or in delta cortisol response of less than 7 μg/dL,¹⁵ or (3) delta cortisol response of 9.0 μg/dL or less¹⁶ after cosyntropin stimulation, and (4) random cortisol level of less than 25 μg/dL in a highly stressed patient.¹⁷ Studies using corticosteroids in the treatment of adrenal insufficiency in critically ill patients have demonstrated decreased mortality.^16,18

Hypothyroidism, in addition to adrenal insufficiency, may contribute to the hemodynamic instability of critically ill patients in the surgical intensive care unit. Since treating patients with glucocorticoids has been reported to lower total T₃, total T₄, and TSH levels,^19,20 concurrent TSH testing at the time of adrenal testing may be indicated to prevent masking of hypothyroidism once glucocorticoid treatment is initiated. The purpose of this study is to assess the incidence of concurrent hypothyroidism and adrenal insufficiency in a population of critically ill patients with severe sepsis, septic shock, and hemorrhagic shock.

This is a prospective observational study carried out in the surgical intensive care unit of the Queen’s Medical Center, Honolulu, Hawaii, a university-affiliated tertiary medical center. The study was approved by the Queen’s Medical Center institutional review board. Informed consent was obtained from all patients or their families. The study population consisted of 66 admitted patients having the diagnosis of severe sepsis, septic shock, as previously defined by consensus conference,²¹ or hemorrhagic shock who underwent pulmonary artery catheter insertion for cardiovascular optimization and fluid management. Hemorrhagic shock was defined as blood requirement of 12 U or more of packed red blood cells within 12 hours with total fluid requirement of more than 6 L in 6 hours²² and hypotension, defined as a systolic blood pressure less than 90 mm Hg or a 40-mm Hg or more decrease from baseline. Patients were excluded if they had known adrenal or thyroid insufficiency or glucocorticoid or levothyroxine sodium use within the last year. Also excluded were children (<18 years old) and patients with severe irreversible head injury, uncontrolled neoplastic disease, or do-not-resuscitate orders.

Within 24 hours of pulmonary artery catheter insertion, blood samples were obtained at 3 AM for measurement of TSH and baseline cortisol concentrations. This was immediately followed by intravenous injection of 250 μg of cosyntropin (Cortrosyn; Organon Inc, West Orange, NJ). Cortisol levels were again obtained 1 hour after cosyntropin stimulation. Thyroid and adrenal testing was repeated as clinically indicated during the course of the surgical intensive care unit stay. The cortisol concentration was measured using paramagnetic particle, competitive binding, chemiluminescent immunoassay (Beckman Access Immunoassay system; Beckman Coulter Inc, Fullerton, Calif). The TSH level was measured using 2-step paramagnetic particle, chemiluminescent enzyme immunoassay (Beckman Access Immunoassay system; Beckman Coulter Inc).

The reference range for TSH level in our laboratory is 0.24 to 3.80 mU/L. Hypothyroidism was defined as TSH concentration greater than 3.80 mU/L. Adrenal insufficiency was defined as a baseline cortisol level of less than 18 μg/dL, and/or cortisol response of less than 7 μg/dL after 250-μg cosyntropin stimulation.¹⁵ Organ dysfunction, as previously defined,²³ and Acute Physiology and Chronic Health Evaluation (APACHE) II²⁴ scores were determined for all patients within 24 hours of enrollment in the study. Injury Severity Score and Trauma and Injury Severity Score were assessed for trauma victims in the study.

A total of 66 consecutive patients were studied. Patient demographics are listed in Table 1. Of the 58 patients with severe sepsis and septic shock, 10 (17.3%) were trauma patients. All 10 patients sustained blunt trauma with multiple injuries. Of the 66 patients, 5 patients (7.6%) had only hypothyroidism and 35 patients (53.0%) had only adrenal insufficiency. Eight patients (12.1%) had hypothyroidism and adrenal insufficiency and 18 patients (27.3%) had neither. There was no statistically significant differences in age or APACHE II scores between the groups with the different endocrine abnormalities. The distribution of these patients among the severe sepsis/septic shock and hemorrhagic shock groups is given in Table 2. Overall mortality was 22.7% (15 of 66 patients) and mortalities of the different groups are listed in Table 3. The mean (SD) TSH level of the patients with hypothyroidism was 8.5 (6.2) mU/L. Of the 43 patients with adrenal insufficiency, 7 patients (16. 2%) had low baseline cortisol levels with normal response to stimulation, 18 (41.8%) had normal baseline cortisol levels but an inadequate response to stimulation, and 18 (41.8%) had a low baseline and an inadequate response to stimulation. Eosinophilia was noted in 6 (14.0%) of 43 patients with adrenal insufficiency.

Hyponatremia (sodium level <136 mEq/L) was noted in 6 patients with adrenal insufficiency, 1 patient with hypothyroidism, and 2 patients with both abnormalities. Hyperkalemia (potassium level >5.0 mEq/L) was found in 2 patients with adrenal insufficiency and 1 patient with hypothyroidism. Hypokalemia (potassium level <3.6 mEq/L) was noted in 5 patients with adrenal insufficiency and 1 patient with hypothyroidism. None of the patients were hypothermic (body temperature <35°C) or hypoglycemic.

All patients found to have hypothyroidism and/or adrenal insufficiency were treated with thyroxine and/or hydrocortisone. Thirty-one of 36 patients with adrenal insufficiency required vasopressor support at the time of diagnosis. After 24 hours of hydrocortisone treatment, they had, on average, a 43% decrease in vasopressor requirement. Two patients initially diagnosed as having only hypothyroidism were noted to have increased hemodynamic instability 4 days after initiation of levothyroxine therapy. They were both tested and found to have new development of adrenal insufficiency.

Both overt and subclinical hypothyroidism has long been recognized to have important clinical effects on cardiac function.¹¹ Patients with subclinical hypothyroidism may demonstrate left ventricular diastolic dysfunction from delayed relaxation, and systolic dysfunction on effort resulting in poor exercise capacity.¹² These patients also have an increased risk for atherosclerosis, myocardial infarction, and cardiovascular death. Hypothyroidism has also been associated with increased heart rate, atrial arrhythmias, and increased left ventricular mass with marginal concentric remodeling. ¹¹ These abnormalities are reversible when treated with levothyroxine to restore euthyroidism.¹²

The TSH concentration elevations in our study differ from the well-recognized thyroid abnormality in critically ill patients known as the nonthyroidal illness syndrome or the euthyroid sick syndrome. In the euthyroid sick syndrome the first and most consistent thyroid hormone abnormality is a decrease in T₃level. With increased severity and duration of illness, the T₄ level is decreased as well, owing in part to a decrease in T₄ production. Thyrotropin levels in these patients are typically within or below the reference range during the acute phase of critical illness and only rise to above normal levels during recovery.^1,25,26 Our study measured the serum TSH level during the acute phase of the critical illness, when TSH concentration elevation most likely reflects true hypothyroidism. Although T₄ levels were not obtained in this study, the serum TSH concentration is believed to be the single best test to discern patients with true abnormal thyroid function who require treatment from those with euthyroid sick syndrome.³

Studies on the treatment of critically ill patients using T₃ and T₄ level replacements have yielded conflicting results and the appropriateness of treatment remains controversial.^7-9,26 Brent and Hershman²⁷ randomized intensive care unit patients to receive intravenous thyroxine vs placebo for 2 weeks and found that the 12 treated patients had normal serum T₄ levels but that mortality in both groups was similar. Becker et al²⁸ administered T₃ to severely burned patients and showed that free T₃ indices were normalized but there was no reduction in mortality. These^27,28 and other similar studies^7-9,26 do not specify whether TSH levels were elevated in the treated patients. Recently, Inan et al²⁹ found that thyroid hormone supplementation in septic rats resulted in lowered mortality. Most animal studies have shown no clear benefit or harm from triiodothyronine or thyroxine treatment^7,26 but there is a lack of data on treating subjects with elevated TSH levels and whether this influences outcome.

Adrenal insufficiency is increasingly recognized to be common in critically ill patients. Annane et al³⁰ found that in patients with septic shock, 54% had adrenal insufficiency. If we applied their criteria (cortisol response of <9.0 μg/dL to cosyntropin stimulation), 36 (54.5%) of our 66 patients would have adrenal insufficiency. Briegel et al¹⁸ randomized 40 critically ill patients with sepsis and hypotension requiring vasopressor support to receive stress-dose hydrocortisone or placebo and found that the group receiving hydrocortisone required less time on vasopressor therapy. Bollaert et al³¹ randomized patients in septic shock to treatment with hydrocortisone vs placebo and found that the treated patients had improved reversal of shock and improved 28-day mortality. Keh et al³² demonstrated that in patients with septic shock, hydrocortisone treatment restored hemodynamic stability and attenuated the systemic inflammatory response. A prospective randomized trial with 300 patients in France with refractory septic shock and adrenal insufficiencydemonstrateda significant survival benefit when treated with corticosteroids.¹⁶

The signs and symptoms of hypothyroidism and adrenal insufficiency are nonspecific and difficult to detect in critically ill patients. Hypothyroidism is associated with lethargy, hypoglycemia, hypothermia, cold intolerance, mental status changes, prolonged deep tendon reflexes, and respiratory depression as well as electrocardiographic changes.³³ In our study, no patient had hypothermia and 1 patient with hypothyroidism had bradycardia. Patients in septic and hemorrhagic shock are frequently intubated, ventilated, and sedated; they also are receiving vasopressor and inotropic support and total parenteral nutrition. They often have mental, pulmonary, cardiovascular, renal, and hepatic dysfunction that can easily mask the presence of hypothyroidism as well as adrenal insufficiency. Symptoms such as hypotension, hypoglycemia, tachycardia, hypovolemia, or hyponatremia; decreased myocardial contractility; and decreased vascular tone may be attributed to underlying diseases and treatments rather than to hormonal failure. In our study, hyponatremia occurred in 8 (18.6%) of 43 patients with adrenal insufficiency and 3 (23.0%) of 13 patients with hypothyroidism. All of our patients received enteral and/or parenteral nutritional support or glucose-containing intravenous fluids. No patient was hypoglycemic.

Eosinophilia, defined as an eosinophil count greater than 3% of the total white blood cell count, has been reported as a marker of adrenal insufficiency.^15,34 In this study, 6 (14.0%) of our 43 patients with adrenal insufficiency had eosinophilia. Therefore testing for adrenal insufficiency should be considered in hemodynamically unstable patients with eosinophilia. ^15,34

Treatment of hypothyroidism with thyroxine has been reported to precipitate addisonian crisis in patients who also have adrenal insufficiency.^15,35-37 This may be due to an increase in metabolic rate induced by thyroid replacement therapy resulting in overt manifestations of adrenal insufficiency. In our study, 2 patients with hypothyroidism developed hemodynamic instability and were diagnosed as having adrenal insufficiency after 4 days of thyroxine therapy. Both patients initially had normal adrenal function test results. Corticosteroids have been shown to suppress TSH levels into the reference range in patients with hypothyroidism.^19,38,39 It is possible that in patients treated for adrenal insufficiency, concomitant hypothyroidism may remain undiagnosed if therapy with corticosteroids are started before TSH levels are measured.

In our study, patients with severe sepsis, septic shock, and hemorrhagic shock had a 12. 0% incidence of concurrent hypothyroidism and adrenal insufficiency. It has been reported that 25% of patients with Addison disease have hypothyroidism.³⁷ In our study, 8 (18.6%) of the 43 patients with adrenal insufficiency also had hypothyroidism.

One limitation of our study is that the levels of T₃ andT₄ were not tested in patients with elevated TSH concentrations. Except on rare occasions, serum TSH concentration provides a precise and specific barometer of the patient’s thyroid status⁴⁰ and is believed to be the single best test to differentiate between patients with true abnormal thyroid function and those with euthyroid sick syndrome.³ Patients with the euthyroid sick syndrome typically have TSH levels within or below the reference range during the acute phase of their critical illness and only have above-normal levels of TSH during the recovery phase.^1,25,26 Although we measured TSH levels during the acute phase of the critical illness, when TSH elevation most likely reflects true hypothyroidism, T₃ and T₄ levels would have allowed us to differentiate between patients with clinical and subclinical hypothyroidism.

Another limitation is that this is not a prospective randomized trial with treatment outcomes. Surks et al⁴¹ recently published a review of 195 studies on subclinical thyroid disease and concluded that there is insufficient data to support routine treatment. Our study population consists of critically ill, hemodynamically unstable patients. No clear adverse outcomes have resulted from treatment with triiodothyronine and thyroxine in this population.^7-9,26-28 Because of the severity of their illnesses, and the known adverse cardiovascular effects of subclinical hypothyroidism,^11,12 all patients with endocrine abnormalities were treated. Our mortality rate of 22.7% compares favorably with other studies of severe sepsis, septic shock,^42,43 and hemorrhagic shock.⁴⁴ Treatment of adrenal insufficiency has been shown to improve outcomes but the treatment of subclinical hypothyroidism will need further study. The current evidence suggests that treatment of hypothyroidism and adrenal insufficiency may improve the outcome of these critically ill patients.

To avoid missing the diagnosis of hypothyroidism or precipitating addisonian crisis in patients with adrenal insufficiency, the routine testing for both abnormalities in this population of patients may be warranted. There seems to be a close association between adrenal and thyroid dysfunction. Treatment of hypothyroidism may unmask adrenal insufficiency,¹⁵ although it is possible that adrenal insufficiency developed later in the intensive care unit course. Repeated checks of both hormonal functions in patients who remain unstable or develop instability may be warranted as well.

Correspondence: Mihae Yu, MD, Department of Surgery, Division of Surgical Critical Care, John A. Burns School of Medicine, University of Hawaii, Queen’s Medical Center, 1356 Lusitana St, Sixth Floor, Honolulu,Hawaii 96813 (mihaey@hawaii. edu).

Accepted for Publication: May 20, 2004.

Funding/Support: This study was supported in part by the Queen Emma Foundation, Honolulu.

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Thyroid, Adrenal, Hormone Therapy | Wash DC, MD

Symptoms of a Thyroid Problem, Adrenal Fatigue and/or Hormonal Imbalance

• Low body temperature / coldness
• Brain fog / poor memory, focus and concentration
• Low energy / fatigue
• Depression / anxiety
• Immune dysfunction / allergies / recurrent infections
• Fibromyalgia and arthritic pain
• Poor connective tissue quality / poor healing
• Inability to hold chiropractic / osteopathic adjustments
• Weight problems: can’t lose or can’t gain

Could low metabolic energy/low body temperature be affecting your health?

These common symptoms may seem unrelated but they may all stem from the same root problem of low metabolic energy. While the list of problems above seem like nothing more than day-to-day annoyances, in reality all are symptoms of low metabolic energy. The best way to eliminate these symptoms – and restore metabolic energy – is to correct the underlying problem.

What causes low metabolic energy? The most common cause is thyroid problems and/or adrenal fatigue or dsyfunction. Another very common cause is hormonal imbalance – especially low progesterone or estrogen dominance in women or low testosterone in men. Restoring metabolic energy helps the body help itself, letting the self repair mechanisms function well again and restore health.

A holistic approach to thyroid, adrenal and hormone correction to regain energy and balance.

Proper evaluation of the thyroid, adrenals and female/male hormones and treatment using prescription, natural hormone therapy or bioidentical hormone replacement and supplements is essential to address the root cause of the problem, restore physiologic balance, and restore normal healthy function.

* Metabolic Scorecard™: A method for looking at symptoms to provide guidance on whether there are adrenal, thyroid, or a mixture of problems.

* Thyroid Scale™: A method of evaluating thyroid lab data (TSH, Free T4, and Free T3) relating them to optimal values as well as each other. This provides a clearer picture of what is going on as opposed to the old, ‘your lab values are all normal’, answer.

* Estrogen Dominance Questionnaire: A method of looking at symptoms to determine if an estrogen / progesterone imbalance might be causing metabolic problems.

Are Your Hormones in Balance? Schedule now to check! 

What Causes Low Metabolic Energy?

Every process that goes on inside our bodies requires energy – specifically, metabolic energy. When the body doesn’t have enough energy to function properly, each component of the body will malfunction in its own unique way.

The thyroid gland, located at the base of the neck, makes the hormone T4 (thyroxine). T4 converts to T3 (triiodothyronine) and RT3 (reverse T3). The T3 turns on the ATP (energy) making machinery inside each living cell while the RT3 slows it down. Production of these thyroid hormones is controlled by TSH (Thyroid Stimulating Hormone), which is released by the pituitary gland in the brain. The pituitary takes its orders from the hypothalamus (also part of the brain). The adrenal glands, located on top of each kidney, help the body deal with stress. If the metabolic activity is excessive, the adrenals perceive this as a stress. In response to this stress, the hypothalamus will signal the pituitary to produce less TSH, thus producing decreased T4 and thyroid activity.

Based on the above explanation, some of the contributors to low metabolic energy are:

* The thyroid gland can not make enough T4 (hypothyroidism).

* The adrenal glands are too weak to handle the stress of the body’s normal metabolic energy

* The enzymes which make ATP may be held back due to toxins, lack of vitamins or minerals, or breakdown due to auto-immune disease or   old viral damage.

* Hormonal imbalance such as growth hormone, testosterone, estrogen, or progesterone

* Severe caloric restriction.

As discussed earlier, when one or a combination of these factors is in place the symptoms of low metabolic energy – such as fatigue, weight issues, memory loss, cold hands, dry skin – may start to appear.

The Thyroid/ Adrenal Relationship

If both the thyroid and the adrenals are weak, adrenal repair must precede thyroid repair (see Metabolic Scorecard™ to determine whether problem is adrenal, thyroid, or both). If the adrenals are weak, then even normal thyroid activity places an excessive burden on them. One may begin to feel ‘hypoadrenal’ (coldness, weight loss, dryness, fatigue, insomnia, and/or anxiety) and then the body innately turns down its own thyroid energy production by increasing production of RT3. Conversely, if the adrenals are strong and the thyroid is weak or unable to keep up with the adrenals, one begins to feel ‘hypothyroid’ (heat intolerance, weight gain and fluid retention, tiredness, excessive need to sleep and/or depression). A very common error made by medical practitioners is to focus entirely on the thyroid and ignore the adrenals.  In a weakened adrenal state, prescribing thyroid medication that contains T4 and/or T3 may produce limited or transient improvement. Subsequent increases of the dose offer little or no benefit as the medication pushes the energy machinery into overdrive. Unfortunately, this higher energy level is unsustainable due to the stress on the adrenals. Eventually the adrenals become fatigued and the symptoms of low energy return. If, however, the adrenals are functioning well, the thyroid hormones can do their job and the result is good metabolic energy.

Another way of looking at this thyroid/adrenal relationship is to think of the thyroid as ‘generating’ the energy while the adrenals need to be able to ‘handle’ the energy. If the thyroid generated energy is excessive for the adrenals’ ability to handle it, the body will down-regulate the thyroid energy as much as it is capable of doing to accommodate what the adrenals can safely handle.

Adrenal Repair Basics

In general, stress hurts the adrenals. We can define stress as anything which challenges our survival, joy, prosperity, security or stability. It is anything which forces our system to adapt such as infection, lack of sleep or even lack of love are stressors. The opposite of stress such as joy, sleep and rest, comfort, peace, security, stability, and good nutrition, are examples of things that help the adrenals.

Avoid the stressors and seek out those things that help. Eat more proteins (especially amino acids) and healthy fats. Limit carbohydrates, especially sugars. Avoid stimulants and stressful substances such as caffeine, diet pills, alcohol, cigarettes, etc. If you have allergies, avoid the allergens – common allergens are wheat and dairy.

Metabolic activity, the chemical processes and changes going on in our body, represent a stress. At a level that can be handled by the adrenals, this stress is good for us (Eustress) and maintains life. If metabolic activity is too strong for the adrenals (e.g., excessive thyroid stimulation), it is at a level that is unhealthy (Distress) and wears the adrenals down.

Mold is a common serious stress but difficult to avoid. Reduce stress as much as possible. Look for opportunities to experience security, joy and optimism and avoid negative emotions such as fear and anger. Get as much sleep as possible and make the timing as regular as possible. Pushing too hard, excessive work or exercise, and any sleep deprivation stresses the adrenals.

Adrenal Support with Supplements and Healthy Food

Providing the body with proper support in the form of vitamin supplements is critical to repair. The minimal nutritional requirements for healthier adrenals are:

* A healthy whole food organic diet which contains an adequate amount of protein and healthy fats, adequate fat soluble vitamins, and without anything you are allergic to (e.g., wheat, dairy, or other specific foods you might be allergic to). Sometimes eating right for your blood type becomes the key factor.

* B-Complex Vitamins: A very complete B-complex with lots of Vitamin B-5.

* Vitamin C and Antioxidants: The buffered powder form of Vitamin C is often most easily tolerated as part of a drink sipped throughout the day. It is important to take bioflavonoids with Vitamin C as these help recycle and sustain the antioxidant activity.

* Amino Acids: Individuals with weak adrenals often cannot digest meat or proteins into amino acids very well. The adrenals thrive on amino acids. As with the Vitamin C, amino acids are best taken as part of a drink sipped throughout the day.

* Healthy Fats: Animal fat is the best source of healthy fat but they need to be organic. If dairy or meat, the animal should, if possible, be grass fed cow or sheep. Eggs are also healthy. Free range hens are the best source.

* Unrefined Sea Salt: This helps the adrenals by raising a low blood pressure and assisting the body in retaining water. Plain table salt does not contain the same minerals and some people feel poorly with it.

A Holistic Approach to Correcting Thyroid Problems and Restoring Function

Thyroid hormone receptors are affected by our diet and our exposure to Halogens like flouride (water, toothpaste), Chlorine, Bromine (white bread) and Astatine or it’s Isotope Radon. The halogens compete with Iodine for the receptor. Thyroid hormone production needs a healthy dose of selenium and zinc, and we need a healthy liver to convert T4 to its active hormone T3. The approach to thyroid imbalance is a clear example of the need to uncover the root cause of the problem.

For mildly poor thyroid function, one can often get the needed support with supplements such as L-Tyrosine and iodine (e.g. Prolamine Iodine) or a thyroid supporting glandular supplement (e.g. T-100). Supplements containing mixtures of thyroid nutrients are also available. Some thyroid glandular may offer more complete support.

If the thyroid condition is more severe, one may require prescription medication. Giving only T4 (e.g. Levothyroxine, Synthroid, Unithroid, Levoxyl etc) is a good choice if T4 is the only missing component. In individuals with poor conversion of T4 to T3, a desiccated thyroid preparation (e.g. Armour Thyroid Rx) often works best because it contains the needed T3 as well. Breaking up the dose into two or three doses daily provides a more stable blood level of T3 and generally produces better results. Taking the daily dose all at once in the morning tends to be stressful on the adrenals and often leaves one feeling depleted by afternoon. Evidence of this can be seen when taking daily temperatures. The adrenal stress shows up as increased temperature volatility.

Note that if the adrenals are too weak to handle the desiccated thyroid (Rx) then we often see an initial response of better energy and fewer symptoms followed by a later ‘crash’ in which energy can drop to even lower levels than before the desiccated thyroid support. Additionally, other symptoms of adrenal stress such as anxiety, insomnia, and palpitations can then occur. The same can be seen with fast release T3 (e.g. Cytomel) or with slow release T3.

Estrogen Dominance Support (for women)

Estrogen is generally a stimulant and presents as anxiety, agitation, muscle tension, increased cell division in female organs (e.g., uterine fibroids, breast cysts etc.) Conversely, progesterone has a calming effect such as sedation, slowed cell division etc. An imbalance which favors a predominance of the estrogenic effect evidenced by either excessive estrogen or insufficient progesterone, is called estrogen dominance.

Metabolic Energy

As you can see, low metabolic energy can appear as any of numerous symptoms. The best way to eliminate the symptoms is to correct the underlying problem – in most cases, poor thyroid and adrenal function. Once you’ve made the choice to correct the problem, some general principles of treatment apply:

* If the treatment is working, one should feel improvement as time goes on. Healing crises rarely occur with thyroid and adrenal repair. They tend to occur more often with detoxification or elimination of a biological agent.

* Successful treatment is achieved more easily through the use of feedback based on changing signs, symptoms, temperature patterns and lab values.

* When taking supplements, especially for those who are highly sensitive or have allergies, the old nursing adage of ‘start low, go slow’ is very important to remember when restoring adrenal and thyroid function. It is the adrenal component that is least understood or appreciated. Yet, as you can see from this article both thyroid and adrenal function can be enhanced using supplement support and lifestyle changes. And, as a result, supplement support and lifestyle changes can help you start living a normal, ‘symptom’ free life.

adrenal gland – Thyroid Endocrine

In humans there are two adrenal glands one each on the left and right side. It is located just superior to the upper pole of the kidney. It weighs about 5gms each. It produces hormones like glucocorticoids, mineralocorticoids and sex hormones. The inner part of the adrenal gland is the adrenal medulla which produces epinephrines and norepinephrines.

Adrenal Disorder

The adrenal glands are two glands that sit on top of your kidneys that are made up of two distinct parts.

The adrenal cortex — the outer part of the gland — produces hormones that are vital to life,
such as cortisol (which helps regulate metabolism and helps your body respond to stress) and aldosterone
(which helps control blood pressure).

The adrenal medulla — the inner part of the gland — produces nonessential
(that is, you don’t need them to live) hormones, such as adrenaline (which helps your body react to stress).

Anatomy of the Adrenal Glands

The adrenal glands are two, triangular-shaped organs that measure about 1.5 inches in height
and 3 inches in length. They are located on top of each kidney. Their name
directly relates to their location (ad—near or at; renes—kidneys). Each adrenal
gland is comprised of two distinct structures—the outer part of the adrenal glands is
called the adrenal cortex. The inner region is known as the adrenal medulla.

Hormones of the Adrenal Glands

The adrenal cortex and the adrenal medulla have very different functions.
One of the main distinctions between them is that the hormones released by
the adrenal cortex are necessary for life; those secreted by the adrenal medulla are not.

Adrenal Cortex Hormones

The adrenal cortex produces two main groups of
corticosteroid hormones—glucocorticoids and mineralocorticoids.
The release of glucocorticoids is triggered by the hypothalamus and pituitary.
Mineralocorticoids are mediated by signals triggered by the kidney. When the
hypothalamus produces corticotrophin-releasing hormone (CRH), it stimulates
the pituitary gland to release adrenal corticotrophic hormone (ACTH).
These hormones, in turn, alert the adrenal glands to produce corticosteroid hormones.

Glucocorticoids released by the adrenal cortex include

Hydrocortisone: Commonly known as cortisol, it regulates how the body converts fats,
proteins, and carbohydrates to energy. It also helps regulate blood pressure and cardiovascular function.

Corticosterone: This hormone works with hydrocortisone to regulate immune response and suppress inflammatory reactions.
The principal mineralocorticoid is aldosterone, which maintains the right balance of salt and water while helping control blood pressure.

There is a third class of hormone released by the adrenal cortex,
known as sex steroids or sex hormones. The adrenal cortex releases small
amounts of male and female sex hormones.

Adrenal Medulla Hormones

The hormones of the adrenal medulla are released after the sympathetic nervous
system is stimulated, which occurs when you’re stressed. As such, the adrenal
medulla helps you deal with physical and emotional stress. Hormones secreted by the adrenal medulla are:

Epinephrine: Most people know epinephrine by its other name—adrenaline.
This hormone rapidly responds to stress by increasing your heart rate and rushing
blood to the muscles and brain. It also spikes your blood sugar level by helping convert
glycogen to glucose in the liver. (Glycogen is the liver’s storage form of glucose.)

Norepinephrine: Also known as noradrenaline, this hormone works with epinephrine in
responding to stress. However, it can cause vasoconstriction (the narrowing of blood vessels).
This results in high blood pressure.

Disorders and Diseases of the Adrenal Glands

Addison’s disease: This rare disorder may affect anyone at any age.
It develops when the adrenal cortex fails to produce enough
cortisol and aldosterone.

Adrenal cancer: Adrenal cancer is aggressive cancer, but it’s very rare.
Malignant adrenal tumors are rarely confined to the adrenal glands—they tend to spread to
other organs and cause adverse changes within the body because of the excess hormones they produce.

Cushing’s syndrome: Cushing’s syndrome is an uncommon condition that is essentially
the opposite of Addison’s disease. It is caused by overproduction of the hormone cortisol.
There are a variety of causes of this disorder—a tumor in the adrenal gland or
pituitary gland could be to blame.

Pheochromocytoma: This results in hypertension with
periodic attacks of palpitations and headache

Congenital adrenal hyperplasia: This genetic disorder is
characterized by low levels of cortisol. It’s common for people with congenital
adrenal hyperplasia to have additional hormone problems such as low
levels of aldosterone (which maintains a balance of water and salt).

Thyroid gland. Problems. Signs of dysfunction

Chronic fatigue syndrome.How hormones get tired of us / Habr

Metabolism in the body is regulated by glands that produce hormones. The control of hormones belongs to the pituitary gland, which is controlled by the hypothalamus. The hypothalamus is the body’s defense system, its fuse, and it often turns off during CFS due to lack of energy.

Due to the increased level of stress, hormonal problems are not uncommon today, especially in urban environments.

Due to the constant haste and lack of time, we often do not notice signals from our body, such as increased fatigue and irritability, and they may indicate a disruption in its work and disruptions in the hormonal system.
This is what the article will discuss.

Adrenal glands

These are paired endocrine glands responsible for the stress response of the body and helping to balance the defense systems, as well as maintaining blood pressure.

Disorders in the adrenal glands lead to increased fatigue, fatigue, decreased immunity and, consequently, frequent infectious diseases. Also common hypoglycemia , allergies and decreased stress resistance.

Thyroid

The thyroid gland is responsible for accelerating and slowing down the body’s metabolism, and its dysfunction is expressed in increased fatigue, unnecessary pain, weight gain and some other side effects.

Reproductive glands

Surprisingly, they are responsible for reproductive functions. For example, a decrease in testosterone leads to pain, fatigue, and decreased libido.

Before moving on to the dysfunctions of the glands and the consequences of a lack of hormones, you should understand: you cannot rely only on blood tests for hormones – they can give unreliable results.

To determine the norm for hormone tests, a sample is taken from a large number of test results and two standards of deviation are allocated – 2.5% of the lowest and highest indicators. All other results are considered normal.

Due to this, antibodies that attack the thyroid gland were found in 19% of “healthy” people from the control group.

Therefore, if you set a goal to cure CFS and restore hormonal balance, be aware that the method of treatment should be based primarily on the symptoms, and the test results should be used only as additional and clarifying information.

The functions of the adrenal glands are controlled by the autonomic nervous system and

adrenaline

is produced in them.

Disruption of the adrenal glands leads to neurotransmitter hypotension, apostural orthostatic tachycardia syndrome, panic attacks, and hot and cold sweating may also occur.

The adrenal glands also synthesize hormones that regulate stress, the immune function of the body and maintain the level of blood pressure:

• Cortisol. The body’s response to stress is to increase the production of cortisol. It is responsible for raising blood sugar, blood pressure levels and regulating the immune system. With a decrease in cortisol, fatigue is felt, blood pressure and hypoglycemia decrease, immunity deteriorates, the chance of allergic reactions increases and stress resistance decreases.
• Dehydroepiandrosterone sulfate (DEA-C) . The functions of this hormone are not yet fully understood, but it is he who is synthesized by the adrenal glands in large quantities.With a decrease in DEA-C, malaise is felt. Usually, a decrease in this hormone is associated with age-related changes in the body, but in people suffering from CFS, its level decreases prematurely.

Symptoms of adrenal cortex insufficiency

The main symptoms of adrenal insufficiency are:

• fatigue
• recurrent and long-term infections
• nervous breakdowns, especially under stress
• hypoglycemia
• low blood pressure

Simple hypoglycemia test

If, during hunger, a person is irritated to the state of “Now give me something to eat or I will kill you!”, Then, most likely, his blood sugar content is low.

Adrenal fatigue

With adrenal fatigue, people experience periods of nervousness, dizziness, and become irritable and tired.

But after eating something sweet, you feel relief, as it briefly raises energy levels and mood. Often adrenaline fatigue sufferers are addicted to sweets.

Sweet for a while raises the blood sugar level to normal, and the condition improves, but soon the sugar level drops again and the state of health worsens.

If you are irritated when you are hungry, it doesn’t hurt to check the adrenal glands.

Sugar is the only “fuel” used by the brain. Therefore, with a decrease in blood sugar, a person feels anxiety, irritation, and then fatigue.

Problems with checking adrenal function

When testing adrenal function in a laboratory, cortisol levels are examined. But defining a low cortisol level, when it hits 2.5% of the lowest, means that, more often than not, the adrenal glands are already damaged and this poses a threat to life.

Most people have morning cortisol levels of 16-20 mcg / dl, but even a reading of 6.1 mcg / dl is considered normal, which is at least three times lower than the norm for a healthy person.

To determine if the adrenal cortex is inadequate, the cortisol level must be below 6 μg / dL, while 5.9 μg / dL is considered life-threatening.

The difference between “normal” and “life-threatening” readings is only 0.1 mcg / dl, but unfortunately, sometimes there is an error of 8 mcg / dl when two tests are performed from the same blood sample.

Why adrenaline fatigue is becoming more common

The body’s “fight or flight” defense reaction, which is activated in a stressful situation, is designed to save our lives. This reaction ensured the survival of our species, but now it plays a cruel joke on human health.

In those days when survival depended on this mechanism, a person after stress had time to recover – several weeks, and sometimes months.

In today’s society, people experience a stressful response every few minutes.For example, if you are late somewhere, and are stuck in a traffic jam.

Every time you get into a stressful situation, the “fight or flight” reaction is activated, therefore adrenaline fatigue is typical for everyone, even healthy people, but with CFS it is more pronounced.

For starters, you should limit your sugar and caffeine intake. Meals are recommended frequent, but in small portions. Try to avoid white bread, especially those with added sugar, and switch to whole grain breads and vegetables.

Fruit is best consumed in moderation, and fruit juices with sugar are best avoided.

When irritated, eat something high in protein, and for quick relief, put a ¼ – ½ spoonful of sugar under your tongue – this will be enough for a quick energy boost, but not enough for subsequent blood sugar drops.

Here are some drugs that can help bring the adrenal glands back to normal:

• Vitamin C. The optimal dose is 500 mg.
• Vitamin B5 , or pantothenic acid, supports adrenal function.The dosage is 50-150 mg per day.
• Licorice , also known as licorice, reduces adrenal dysfunction and helps maintain optimal hormone levels in the body. Licorice also helps with digestive problems and relieve heartburn. However, be careful when taking licorice – high dosage raises cortisol levels and raises blood pressure. With high blood pressure, you should not take licorice. A safe dose of 200-400 mg of licorice extract per day.
• Chromium helps reduce symptoms of low blood sugar.The dosage is 200-400 mcg per day.

Potential cortisol toxicity

Any medications containing cortisol should be strictly monitored by your doctor.

Thyroid problems are common in CFS, as in everyday fatigue.

The thyroid gland controls the rate of metabolic processes in the body, and with dysfunction of the thyroid gland, a person gains excess weight, it becomes difficult to tolerate cold, fatigue and pain appear, as well as a feeling of confusion.

Two thyroid hormones:

1. Thyroxine (T4) – the main form of thyroid hormones of the thyroid gland, a prohormone to triiodothyronine (T3) – the active form of thyroid hormones of the thyroid gland. Most thyroid hormones are composed of pure T4. They are prescribed when the body is unable to convert T4 to T3, which is common in patients with CFS.
2. Triiodothyronine (T3) is the active form of thyroid hormones.

There can be many reasons for thyroid dysfunction, for example, with everyday fatigue, a common cause is

an autoimmune thyroid disorder

.As a result, the immune system attacks and destroys the thyroid gland, diagnosed by testing for antibodies to thyroid peroxidase. The test for antibodies to thyroperoxidase is one of the few blood tests that gives a direct and unambiguous result.

Another cause of thyroid problems in CFS is hypothalamic dysfunction. At the same time, the body sometimes is not able to transform T4 into T3 completely or in sufficient volume, and it requires a higher level of T3. This ailment is called thyroid hormone receptor resistance.

Problem with thyroid tests

To date, there are no accurate tests for changes in T3 function, and treatment can only be obtained with critically low T4 values, when the results are included in the 2.5% of tests with the lowest results.

If the attending physician does not know the individual level of hormones in the patient, then the test results cannot provide enough useful information.

Therefore, most often with complaints of weight gain and cold intolerance, even if free thyroxine is not in the lower 2.5% of indicators, the patient will need thyroid hormone therapy.

Attention: any means of thyroid therapy are prescribed and used only under the strict supervision of the attending physician. See an endocrinologist or therapist.

When using thyroid therapy, attention should be paid to increased heart rate and increased excitation of the nervous system: if the pulse is above 90 beats per minute, the dosage of the drug should be reduced. At the same time, an increase in heart rate is typical for patients with CFS.
Also, thyroid hormones should not be taken within six hours of taking iron or calcium supplements, as the hormones will not be absorbed.

After the attending physician has determined the nature and dosage of suitable thyroid therapy, the level of free thyroxine in the blood should be checked within six weeks after starting treatment.

Potential side effects

For blood clots in the arteries, thyroid therapy can trigger a heart attack or angina pectoris, just like exercise.

Also, thyroid therapy can increase the heart rate, and if you feel chest pains, you should stop taking medication and see a doctor.

In the long term, thyroid therapy for asymptomatic hypothyroidism reduces the risk of heart disease by 39%.

Often, when reaching middle age, men have a decrease in the level of

testosterone

. This leads to symptoms: fatigue, depression, loss of motivation, irritability, decreased concentration, memory problems, pain.

The main symptoms indicating a decrease in testosterone in men:

• Loss of sex drive
• Erectile dysfunction
• Combination of high blood pressure and increased cholesterol
• Diabetes
• CFS and fibromyalgia

If the testosterone level falls and one of the symptoms appears, then the person is prescribed therapy with bioidentical testosterone.

An Important Difference

It is very important to understand the difference between a safe dosage of healthy bioidentical natural testosterone and high doses of synthetic and potentially toxic testosterone, which is sometimes misused in sports.

The second type of testosterone is called “steroids” and can be very harmful to your health.

Attention: if you suspect a low testosterone level, consult a physician or endocrinologist, in no case try to self-medicate and use hormonal therapy without a doctor’s instructions.

Don’t chase high testosterone levels!

Too high a dose of testosterone can initially cause an increase in libido, but soon the body adapts to excess testosterone and increases the production of a protein that binds testosterone and converts it into an inactive form.

Hormonal disorders are becoming more common in both those suffering from CFS and in healthy people.

A blood test may not be enough to determine the need for hormonal support, as it will show if your score is in the 2.5% of the lowest.

If you are experiencing fatigue, pain, gaining excess weight and becoming more difficult to tolerate the cold – check the thyroid gland.

If you become too irritable when hungry, then get tested for adrenal dysfunction.

Optimizing testosterone levels is important for men, especially if you are experiencing chronic pain.

Read more articles on our blog:

SmartTalks

Source:

Jacob Teitelbaum
Forever tired. How to cope with chronic fatigue syndrome
Introductory article on chronic fatigue syndrome
An article on sleep problems and their connection with CFS

Publisher: Mann, Ivanov and Ferber, 2017

Treatment and diagnosis of causes and symptoms in Moscow

Adrenal hormones

In the adrenal medulla , the following are produced:

• Adrenaline is an important hormone in the fight against stress. The activation of this hormone and its production increases both with positive emotions and stress, trauma.Under the influence of adrenaline, the pupils can enlarge and dilate, breathing becomes faster, blood pressure increases, and a surge of strength is felt. Resistance to pain increases.
• Norepinephrine is a stress hormone believed to be the precursor of adrenaline. It has a lesser effect on the body, participates in the regulation of blood pressure, which helps to stimulate the work of the heart muscle.
• The adrenal cortex produces hormones of the corticosteroid class, which are divided into three layers: glomerular, bundle, reticular zone.

Cells of the glomerular zone produce:

• Aldosterone is a hormone responsible for the exchange of potassium and sodium ions in human blood. Participates in water-salt metabolism, helps to increase blood circulation, increases blood pressure 90 150
• Corticosterone – an inactive hormone, participates in the water-salt balance
• Deoxycorticosterone – a hormone that increases resistance in the human body, gives strength to muscles and skeleton, also regulates water-salt balance 90 150

Hormones of the bundle zone of the adrenal glands:

• Cortisol – a hormone that preserves the body’s energy resources, participates in carbohydrate metabolism.Cortisol levels often fluctuate, so in the morning it is much higher than in the evening 90 150
• Corticosterone

Hormones mesh zone :

• Androgens – sex hormones that affect sexual characteristics: libido, increase in muscle mass and strength, body fat, lipids and cholesterol levels in the blood 90 150

Adrenal hormones perform an important function in the human body, their excess or deficiency can lead to disruption throughout the body!

Diagnosis of adrenal tumors

You can help diagnose diseases of the adrenal glands or identify violations in their functionality with the help of a number of examinations, which are prescribed by an endocrinologist after an anamnesis has been taken.

• To make a diagnosis, the doctor determines the hormones of the adrenal glands, which make it possible to identify an excess or deficiency of the latter;
• For adrenal tumors, the main screening diagnostic method is ultrasound;
• A more accurate picture is given by CT or MRI of the abdominal and retroperitoneal organs.

The results of the examination make it possible to draw up a complete picture of the disease, determine the cause, identify certain disorders in the work of the adrenal glands and other organs and, accordingly, prescribe treatment.

Itsenko-Cushing’s syndrome

A pathological symptom complex arising from an increased release of the hormone cortisol by the tumor from the adrenal cortex. The production of cortisol and corticosterone is regulated by the pituitary gland by the production of adrenocorticotropic hormone. The activity of the pituitary gland is controlled by the hormones of the hypothalamus – statins and liberins. This multi-stage regulation is necessary to ensure the coherence of body functions and metabolic processes, a violation of one of the links can cause hypersecretion of adrenal cortex hormones, which will lead to the development of Itsenko-Cushing’s syndrome.Unlike Itsenko-Cushing’s disease, the syndrome is manifested by a primary increase in hyperfunction of the adrenal cortex, while in Insenko-Cushing’s disease, ACTH-producing pituitary adenoma is the basis.

Cause of occurrence:

In 20% of cases, the cause of Itsenko-Cushing’s syndrome is a tumor of their adrenal cortex.

Symptoms:

The most characteristic symptom of the syndrome is obesity according to the cushingoid type (fatty deposits on the face, neck, chest, abdomen, back with relatively thin limbs), the face becomes reddish-purple, muscle atrophy, and a decrease in muscle tone and strength are observed.

Diagnostics:

Determination of the excretion of cortisol in daily urine, determination of cortisol in the blood, determination of ACTH in the blood, conduct a small dexamethasone test (normally taking dexamethasone reduces the level of cortisol, with Itsenko-Kushching syndrome, there is no decrease), CT or MRI of the abdominal organs is performed.

Treatment:

If there is a neoplasm in the adrenal gland, surgical treatment is performed.Symptomatic treatment includes the use of antihypertensive, diuretic, hypoglycemic drugs, cardiac glycosides. With Itsenko-Cushing’s disease, surgical treatment of pituitary adenoma is performed.

Connes syndrome

(primary hyperaldosteronism, aldosteroma) is a symptom complex due to the greater production of aldosterone by the adrenal cortex.

Cause of occurrence:

The cause is most often a tumor of the adrenal gland, less often – hyperplasia of the glomerular zone of the cortex.In patients, the amount of potassium decreases and the concentration of sodium in the blood increases, because of this, blood pressure rises.

Symptoms:

Weakness, fatigue, tachycardia, convulsions, headache, thirst, paresthesia of the extremities, increased blood pressure. Conn’s syndrome is accompanied by signs of damage to the heart and blood vessels, kidneys, and muscle tissue. Arterial hypertension is malignant and resistant to antihypertensive therapy.

Diagnostics:

Study of blood electrolytes (high sodium, low potassium in the blood), an increase in the level of aldosterone in the plasma, calculation of daily urine output, determination of the level of renin in the blood, the ratio of the activity of aldosterone in plasma and renin, determination of the level of aldosterone in daily urine, CT or MRI of the abdominal organs – definition of neoplasms in the adrenal glands.

Treatment:

Therapeutic measures are aimed at correcting high blood pressure, metabolic disorders, as well as preventing possible complications due to high blood pressure and a decrease in potassium in the blood. Conservative therapy is not radically capable of improving the condition of patients; full recovery occurs only after surgical removal of the tumor.

Pheochromocytoma

A hormonally active tumor that actively secretes adrenaline and norepinephrine.Most often, pheochromocytoma is a tumor of the adrenal gland.

Symptoms:

Pheochromocytoma leads to the release of adrenaline or norepinephrine into the bloodstream, which leads to the development of specific disorders in patients – a persistent crisis increase in blood pressure (sometimes more than 200/100 mm Hg), not amenable to antihypertensive therapy, heart palpitations.

Diagnostics:

Diagnostics is based on radiation and hormonal research methods.Radiation diagnostics: CT or MRI of the abdominal and retroperitoneal organs.

Hormones:

Determination of the level of chromogranin A, ACTH, aldosterone, renin, blood cortisol, determination of metanephrines, normetanephrines in daily urine is performed. The presence of formation in the adrenal gland, an increase in the level of metanephrines and normetanephrines in daily urine allows suspecting a pheochromocytoma.

Treatment:

The main method of treatment for pheochromocytoma is adrenalectomy with a tumor.The method of access for surgical treatment depends on the size of the tumor, location, hormonal activity.

Preparation for surgery:

Special attention is paid to the preparation for the operation – the tasks of the preoperative preparation of patients with pheochromocytoma are to normalize the blood pressure level, eliminate its dangerous fluctuations during the day, and slow down the heart rate. Doxazosin (Cardura) is used as the main drug used to prepare for surgery.The drug is prescribed at least 2 weeks before the planned operation.

Estroma

Tumor of the adrenal cortex, producing large quantities of female sex hormones – estrogens. As a rule, these tumors are malignant.

Symptoms:

Estromas are very rare, clinically they are manifested in males by impotence, bilateral gynecomastia, fenimization of the physique, and sometimes testicular hypotrophy.In most patients, along with feminization, there are signs of hypersecretion of gluco- and mineralocorticoids.

Diagnostics:

It consists in examining specific hormones in the blood, performing CT or MRI of the abdominal organs.

Treatment:

Removal of an adrenal tumor.

Androsteroma

A hormonally active tumor of the adrenal gland that produces large quantities of male sex hormones.

Symptoms:

In women, menstrual disorder, clitoris hypertrophy, hair growth of the face and body, masculinization of the figure, coarsening of the voice, sometimes male-pattern baldness. In some patients, hypertension and disorders of carbohydrate metabolism in the form of hyperglycemia and a moderate increase in sugar in the urine may be observed. In men, androsteromas are extremely rare and do not show any external signs, so they are diagnosed at a late stage of the disease.

Diagnostics:

It consists in performing CT scan of the abdominal organs or MRI of the abdominal organs, the content of a high titer of androgens and their metabolites in daily urine.

Treatment:

Removal of an adrenal tumor.

Hormonally inactive adrenal tumor

Formation of the adrenal gland, most often of a benign nature, does not produce high amounts of hormones.These adrenal tumors can be of various sizes.

Diagnostics:

Includes hormonal and biochemical blood and urine tests, CT or MRI of the abdominal organs.

Treatment:

Patients with hormonally inactive formations in the adrenal gland less than 3 cm are shown observation, study of hormones in dynamics. When tumors are more than 3 cm in size, or when the tumor grows more than 1 cm per year, surgical treatment is indicated.

Surgical treatment of adrenal tumors at FNKTs FMBA

Currently, adrenal surgeries can be performed:

• Traditional “open” access
• Using high-tech methods (endoscopic operations)

The FNCC Endocrine Surgery Clinic widely uses endoscopic techniques in adrenal surgery.

Endoscopic techniques are less traumatic compared to “open” surgery: during endoscopic operations, only 3 or 4 punctures are made, each with a maximum of 1 cm, patients are less hospitalized, the recovery period is reduced by 2-3 times.The type of surgery is most often determined by the size of the tumor.

Do not postpone the diagnosis and treatment of the disease! Make an appointment with the endocrinologists of the FNKTs FMBA of Russia at any time convenient for you, having previously called by phone or by filling out a special registration form on the website.

Adrenal hormones – Chemist’s Handbook 21

Iodine is also important for many living things, including humans. It is found in the thyroid and adrenal glands.The thyroid hormone thyroxine (an iodine compound) determines the overall rate of vital processes. Iodine is toxic in the form of b. [c.388]

This occurs under the influence of a chemical signaling substance – the hormone adrenaline secreted by the endocrine glands – the adrenal glands. Hormones play precisely the role of signals, since they are effective in negligible amounts. In the blood of an adult, the norm is 0.0000000055 g of adrenaline when frightened or under the influence of a strong affect, this amount increases by about a thousand times, up to [p.309]

A significant excess of thyroxine (hyperthyroidism) is also very dangerous for a person.The first signs of such a disease are mild excitability, rapid heartbeat, etc. With severe hyperfunction of the thyroid gland (thyroid gland), Graves’ disease may develop, characterized by fever, sweating, hand tremors, specific bulging eyes and other signs. Patients suffer from increased nervousness.To combat hyperthyroidism and Graves’ disease, it is necessary to reduce the content of thyroxine in the body (by surgical removal of a part of the thyroid gland or by destroying it with radioactive iodine preparations) or introduce antagonists of it. It should be noted that the various hormones are very closely related to each other. Thus, the formation of thyroxine is largely regulated by a specific thyroid-stimulating hormone produced in the pituitary gland. In turn, thyroxine affects the formation of the adrenaline hormone in the adrenal glands. [c.93]

Thyroid hormones calcitonin and thyroxin, glucocorticoids and adrenaline hormones produced by the adrenal glands, oxalic acid, phytin and excess content of phosphate ions interfere with the absorption of calcium. [c.304]

Hormones of steroid structure, hormones of the adrenal cortex, hormones of the gonads. [c.95]

Corticotropin – stimulates the secretion of hormones by the adrenal cortex – corticosteroids. These hormones during muscle work are [c.221]

Hormones of the anterior pituitary gland have an indirect effect on blood glucose and glycogen levels in the liver. Adrenocorticotropic hormone stimulates the formation of the hormone cortisone in the cortical part of the adrenal glands, and thyroid-stimulating hormone in the thyroid gland of thyroxine. These hormones increase blood glucose levels. [c.84]

An important role was played by the work of the Canadian pathophysiologist Hans Selye on stress – the general syndrome of adaptation (that is, adaptation) and on diseases of adaptation.They established the importance of the endocrine system of the pituitary gland – adrenal glands in the processes of adaptation and in the development of these diseases. The hormones produced by the adrenal glands – catecholamines (adrenaline, norepinephrine) and corticosteroids (cortisone, etc.) predetermine vascular reactions, and from have the pituitary gland (anti-insular hormone), the adrenal cortex (hormones – corti-costerones) and shields and the bottom gland (hormone – thyroxine).All of these glands, also under the control of the central nervous system, cause an increase in blood sugar with their hormones. Therefore, this entire group of hormones is called diabetogenic hormones. [c.247]

With a diet low in carbohydrates, the onset of hypoglycemia stimulates the adrenaline increment in the adrenal medulla. The hormone, entering the liver with the blood, activates phosphorylase and thereby glycogenolysis (breakdown of glycogen in the liver). [c.83]

The hormones of the pancreas – insulin and glucagon, hormones of the adrenal cortex – cortisol and deoxycorticosterone (glucocorticosteroids), adrenaline adrenal medulla (adrenal hormone, growth hormone and growth hormone) are involved in the hormonal regulation of carbohydrate metabolism thyroid hormone. [c.85]

In addition to adrenaline, insulin and glucagon, some other hormones also affect the level of glucose in the blood.For example, it has been established that the adrenal cortex hormone, corticosterone, when administered into the body, causes hyperglycemia. The thyroid hormone thyroxine acts in a similar way. However, it should be noted that corticosterone, unlike adrenaline and glucagon, does not stimulate the breakdown of glycogen in the liver, but causes hyperglycemia, increasing the formation of glucose in the body from other substances (from the products of deamination of amino acids and possibly from glycerol and fatty acids). The hormones of the anterior pituitary gland also affect the content of glucose in the blood and glycogen in the liver.Their action, however, is not direct, but indirect. In the anterior lobe of the pituitary gland, adrenocorticotropic (p. 158) and thyroid-stimulating hormones are formed. The first of them stimulates the formation of hormones (cortisone) in the cortical part of the adrenal glands, the second stimulates the formation of thyroxine in the thyroid gland. Both cortisone and thyroxine increase blood glucose levels. [c.275]

According to the localization of biosynthesis in the body, there are pituitary, hypothalamic, sex hormones, corticosteroids (adrenal cortex hormones), thyroid hormones (thyroid hormones), etc.d. [c.290]

Adrenal glands: who is to blame for fatigue and fear?

Excess weight is always associated with nutritional flaws and gluttony, and fatigue is associated with an intense rhythm of life. Attacks of unexplained fears are attributed to panic attacks and vegetative-vascular dystonia, which are now fashionable, or to psychological problems. All this may be true, or it may be a sign of hormonal imbalance. And the adrenal glands are to blame. And what do we know about them and their role in our mental state? And where to go if the neurologist and psychologist don’t help?

SMALL SPOOL

The spool is small, but expensive – this is about the adrenal glands.Few people know where they are located and what, in principle, they do. Meanwhile, they are extremely important – on our website news.ru we have already written about different endocrine glands. It’s the turn of the adrenal glands.
The adrenal glands are a paired organ located, as the name suggests, above the kidneys. The adrenal glands are united with the kidneys and are only 35 to 70 mm in size. The adrenal glands weigh 14 grams and are mainly composed of the cortex. The brain substance occupies only 10% of the organs. One of them is not like the other, unlike other paired organs: the right adrenal gland resembles a triangle, and the left one is a month.
Hormones are produced in the cortex and medulla. Moreover, their development is also associated with the activity of the pituitary gland. Adrenaline is produced in the medulla. In the cortex, various steroid hormones are produced, which are responsible for sexual characteristics.
A slight deviation in the work of the adrenal glands is enough for a person to start having vegetative crises with unexplained pressure drops from high to low numbers, panic attacks and anxiety attacks. And also in order for a blooming woman to lose signs of femininity and acquire masculine features.

RESPONSIBILITIES OF THE BODIES

The adrenal glands have many roles and functions in the body. They are responsible for our resistance to stress and for our response to external stimuli. Without them, it would have been impossible to react in time and correctly to danger and flee or take a fight, for both the hormones responsible for belligerence and the hormones of fear are produced here.
The adrenal glands are also responsible for the restoration of the nervous system after stress or nervous tension and breakdown. If they went out of order and stopped producing hormones in principle, the nervous system would come to a complete imbalance, which, most likely, would lead to sad consequences.
It is the adrenal glands that are responsible for our second wind and the ability to mobilize strength in critical situations. Thanks to them, a person does not feel tired during urgent work or when it is necessary to make a leap. During this time, the adrenal glands release into the blood a huge amount of hormones, including adrenaline, which allows us to cope with stress and dangers.
But normally, such stress should be short-term. The adrenal glands must help to gather strength into a fist, respond to the stimulus and escape.After that, it is assumed that the person should be safe and the adrenal glands can repair themselves. This is where the problem lies. If the stresses are protracted, then the adrenal glands begin to work in an intensive mode and do not have time to recover. The constant release of hormones into the bloodstream weakens the nervous system, and the adrenal glands themselves are depleted. And this can lead to illness, because even ideally, the effects of stress are eliminated in the body after a couple of days. If there is a cumulative effect, then the body wears out quickly.In this case, at first, the size of the adrenal glands increases, and then they are already depleted.
The adrenal glands help to cope not only with physical and emotional stress, but also with chemical stress. This applies to the effects of all kinds of chemicals, drugs, allergens.

WHAT HORMONES COURT

What hormones are produced by the adrenal glands? They work in a single bundle together with the pituitary gland, the hypothalamus.
In response to stress, adrenaline and cortisol are produced. Adrenaline is responsible for a short-term reaction – to get together and run away or rush into battle.Cortisol, on the other hand, is responsible for resisting stress and adjusting to circumstances. At the same time, it also reduces the amount of cholesterol in the blood, suppresses the immune system, affects the composition of the blood, and increases blood sugar. Normally, the body produces cortisol most of all in the morning, and least of all – at night. When a stressful circumstance arises, the release of cortisol increases. But if a person lives in a state of stress all the time, then gradually the production of cortisol decreases. This is a sign of adrenal depletion.
Also, it is the adrenal glands that produce the hormone aldesterone, which is responsible for regulating blood pressure and water balance in the body, and DHEA-S, from which estrogen and testosterone are then built. As a result of hypothyroidism, a malfunction of the thyroid gland, the adrenal glands can also malfunction and begin to produce little aldesterone.

WHY THEY SUFFER

From all of the above, it becomes clear: the adrenal glands suffer due to the fact that we are a lot and constantly nervous. They are not afraid of short-term stress – they are created in order to cope with it.
But long-term, chronic stress, constant nervous tension or work for wear and tear affect the adrenal glands catastrophically. And the most dangerous thing is that we do not notice it immediately.
As a result of many years of nervous tension, the adrenal glands begin to deplete, and adrenal weakness is formed. At first, this is manifested by a feeling of enduring fatigue, which does not go away even after sleep. By the way, it is believed that the now widespread fashionable diagnosis of “chronic fatigue syndrome” is nothing more than a weakening of the functions of the adrenal glands.
Inadequate nutrition, constant diets, and restricting the intake of the required amount of proteins, fats, carbohydrates, vitamins and minerals can also adversely affect the ability of the adrenal glands to cope with the production of hormones.
In women, the adrenal glands can be affected by taking oral contraceptives. At least, this is the opinion of some researchers, suggesting that interference with the hormonal sphere of the ovaries leads to a malfunction of the adrenal glands later. Synthetic hormones are a poorly proven phenomenon.Until the end, their effect on the body has not been clarified. Oral contraceptives suppress the reproductive system. This leads to some kind of imbalance in the endocrine system. As a result, the adrenal glands may eventually weaken.
Infectious diseases, severe stress can cause disruption of their work. Moreover, if there is congenital weakness of the adrenal glands, then external influences will affect them much faster.
The good news is that the adrenal glands actually resist stress for a long time and have great compensatory power.Therefore, we are able to live in prolonged stress for years. However, retribution will be inevitable if you do not stop in time and begin to realize that constant rushwork, anxiety, rage, fear, hatred and envy are hitting the adrenal glands in the first place.

SYMPTOMS OF PROBLEMS

The first signs of adrenal exhaustion are weakness, fatigue, lethargy, irritability, reduced immunity, and “clinging to all colds and flu.”
The following symptoms indicate that the adrenal glands are working with overload: frequent anxiety for no reason, nervousness and inability to cope with stress; irritability, trembling hands, dizziness, palpitations, headaches, waking up at night, nausea during stress, unreasonable sweating, weakness, cravings for salty and sweets, recurrent panic attacks, inability to concentrate, bouts of anger, inadequate emotional sensitivity.This is expressed in the fact that any events are taken to heart and elevated to catastrophic, and in the fact that it becomes more and more difficult to find a common language with the people around. Exposure is zero, and any event is experienced for a long time.
In this case, a vicious circle is formed: a person who is inclined to “chew” events and worry about every trifle depletes his adrenal glands by being in constant stress, and then the exhausted adrenal glands provoke exactly the same reactions.
With problems with the adrenal glands, hypothyroidism, changes in body weight, a drop in blood glucose, unmotivated pain in the body, pain in the scalp, clumsiness, shortness of breath, frequent urination, muscle weakness, and back pain may occur.
Depletion of the adrenal glands can lead to adrenal disease. The fact that serious diseases have already developed can be indicated by an uncontrolled rise in blood pressure, which is difficult to stop, and a sharp change in body weight. Installation of perimeter security systems in Moscow With certain types of adrenal gland diseases, body weight increases, and fatty cushions are formed in the area of ​​the shoulders, waist, and face. Losing weight is extremely difficult. On the other hand, adrenal dysfunction can sometimes lead to weight loss.A change in skin color also speaks of diseases that have already appeared. Age spots that appear are often referred to as bronze disease.

WHAT TO PAY ATTENTION

If a person constantly feels weak and lethargic, then it is worth checking the adrenal glands. Even in old age, this condition is not normal. If a person experiences weakness in an active working age, then this is not laziness, but a sign of illness.
In some cases, a person can be active for only a few hours.If weakness is combined with nervousness, nervous breakdowns, irritability and headaches, then it is imperative to check the blood for hormones.

WHAT TO DO TO PROTECT ADRENALS

First of all, you need to reconsider your attitude to life in general. Living in constant rush and stress leads to organ disease. And no matter what measures are taken, it will not be possible to strengthen the adrenal glands during life in time trouble.
It is also worth reconsidering the values. Envy, fears, resentment drain the body’s strength and make it live in constant stress and anxiety.
You can start drinking adaptogen herbs to support your adrenal glands. These include St. John’s wort, Rhodiola rosea, Eleutherococcus, licorice, ginkgo biloba, licorice, ginger.
The health of the adrenal glands is supported by fish oil, omega-3 fatty acids, vitamins, especially B and C groups, magnesium, zinc, potassium. All foods rich in these trace elements and vitamins are beneficial for the adrenal glands. These include nuts, avocados, seeds, especially pumpkin seeds, greens, tomatoes, fish, poultry, eggs, cauliflower.Proper nutrition is the key to stress resistance and adrenal health
The adrenal glands are quiet and silent workers. Therefore, it is worth helping them, because, besides them, no one will help us cope with the stresses of our world and live happily.

⇒Dear patients and relatives of patients of the COVID-19 infectious diseases department!

Intermedical | LG

lycoprotein gonadotropic hormone. It is synthesized by basophilic cells of the anterior pituitary gland under the influence of hypothalamic releasing factors.

Stimulates the synthesis of estrogen in women; regulates the secretion of progesterone and the formation of the corpus luteum. Reaching a critical level of LH leads to ovulation and stimulates the synthesis of progesterone in the corpus luteum. In men, by stimulating the formation of sex hormone binding globulin (SHBG), it increases the permeability of the seminiferous tubules for testosterone. This increases the concentration of testosterone in the blood plasma, which contributes to the maturation of sperm. In turn, testosterone re-inhibits the release of LH.In men, LH levels increase by the age of 60 to 65.

The release of the hormone is of a pulsating nature and depends in women on the phase of the ovulation cycle. During puberty, the LH level rises, approaching the values ​​typical for adults. In the menstrual cycle in women, the peak LH concentration falls on ovulation, after which the level of the hormone falls and keeps the entire luteal phase at values ​​lower than in the follicular phase. During pregnancy, the concentration decreases. In the postmenopausal period, there is an increase in the concentration of LH, as well as FSH (follicle-stimulating hormone).In women, the concentration of LH in the blood is maximum in the interval from 12 to 24 hours before ovulation and is retained throughout the day, reaching a concentration 10 times higher than in the non-ovulation period.

The LH / FSH ratio is important. Normally, before menarche, it is equal to 1; after a year of menarche – from 1 to 1.5; in the period from two years after the onset of menarche and before menopause – from 1.5 to 2.

Everything about hormones and their effect on the human body

Hormones are organic substances with high physiological activity, designed to control the functions and regulation of the main body systems.They are secreted by the endocrine glands and released into the bloodstream of the body. The endocrine system consists of endocrine glands that are located in different parts of the body, but are very interrelated in their functions.

The endocrine system includes: the pituitary gland, the thyroid and parathyroid glands, the adrenal gland, the pancreas, the sex glands (in women – the ovaries, in men – the testes, seminal vesicles). From the endocrine glands, these substances enter the bloodstream and through the bloodstream go to their “destinations”, namely to the organs to which its action is directly directed.The same hormone can have several organs on which its action is directed.

Basic functions of all hormones:

• maintenance of the general homeostasis of the organism, i.e. integrity and constancy of its internal environment;
• humoral function – regulation of biological processes through the blood;
• regulation of all processes of growth and reproductive development.

In a healthy body, there must be a hormonal balance in the entire endocrine system as a whole (between the endocrine glands, the nervous system and organs that are targeted by hormones).Even small disturbances in some specific parts of the endocrine system can lead to hormonal imbalance.

Hormones are responsible for the vital activity of the cells that make up a living organism. The sharpness of thinking and the physical ability of the body to cope with the diverse loads on the body depend on them. They affect height and physique, hair color and voice timbre. They control behavior and sex drive. The effect on the psychoemotional state (mood variability, tendency to stress) is also very strong.Insufficient and excessive production of these substances can cause various pathological conditions, since they regulate the function of all cells in the body.

In the human body, these substances are produced by the pituitary gland, thyroid and parathyroid glands, adrenal glands, pancreas and genital glands.

Thyroid hormones:

The thyroid gland synthesizes thyroxine (T3) and triiodothyronine (T 4), which in their structure are iodized derivatives of the amino acid tyrosine.That is why, for the normal functioning of the thyroid gland, iodine is needed and with a lack of this trace element, various diseases of the thyroid gland occur. Thyroid hormones affect the mental and physical development of a person, change in body weight and, most importantly, regulate the normal functioning of the immune system.

The production of these substances in the thyroid gland is regulated by thyroid-stimulating hormone (TSH), which is released by the pituitary gland. In small concentrations, the thyroid gland synthesizes calciotonin, which takes part in phosphorus-calcium metabolism.To determine the functional activity and if any pathology of the thyroid gland is suspected, the level of T3, T4 and TSH in the blood is determined.

In inflammatory processes in the thyroid gland, especially in autoimmune conditions, it is imperative to check the level of antibodies to thyroglobulin (AT-TG) and antibodies to thyroid peroxidase (AT-TPO).

Hormone of the parathyroid glands.

The parathyroid gland is a very small gland that is located behind the thyroid gland, but has a very important function – the synthesis of parathyroid hormone, which regulates the normal level of calcium in the blood.

Pancreatic hormones:

The pancreas secretes insulin and glucagon, which regulate carbohydrate metabolism.

Insulin has a multifaceted effect on metabolism in almost all tissues. Normally, the release of insulin helps to lower the level of glucose in the blood, when insulin secretion is impaired, one of the most common and serious diseases occurs – diabetes mellitus. The need for a blood test for insulin arises in the case of a general examination of a patient who has a metabolic syndrome, or if a woman is diagnosed with polycystic ovaries.

Glucagon increases and prevents a critical drop in blood glucose and thus regulates the balance of glucose. An increased content of glucagon in the blood leads to the development of clinical symptoms of hyperglycemia, while a decrease in its content (and therefore an increased content of insulin) leads to the occurrence of symptoms of hypoglycemia. An increased level in the blood is also noted in diseases such as diabetes mellitus, tumor formation of the pancreas (glucanoma).

Adrenal hormones

The adrenal glands produce cortisol , which plays an important role in the body’s defenses in stressful situations. Cortisol in the adrenal glands is produced under the control of adrenocorticotropic hormone (ACTH), which in turn is synthesized in the pituitary gland. The concentration of cortisol in the blood is determined with arterial hypertension, with suspicion of Itsenko-Cushing’s disease, with premature puberty. In the adrenal glands, in addition to the main cortisol, steroid female and male hormones are also synthesized in small quantities.

Female sex hormones

The main female sex hormones include: estrogens, progesterone, prolactin, FSH, LH (follicle-stimulating and luteinizing hormones).

Estrogens and progesterone are synthesized by the ovaries, while prolactin, FSH, LH are produced in the pituitary gland.

Estrogens (estradiol, estriol, estrone) are produced by the follicular apparatus of the ovaries, the placenta and, in small quantities, by the adrenal glands. In terms of their chemical composition, these are steroids.Estrogens stimulate the growth and development of all female genital organs and play an important role in the formation of secondary sex characteristics in women.

Gestagens (progesterone) are also synthesized by the ovaries, not by follicles, but by the corpus luteum. Together with estrogens, it promotes implantation (attachment) of a fertilized egg to the wall of the uterus. As early as 16 weeks of pregnancy, progesterone begins to be produced in the placenta. The main function of progesterone in the female body is to maintain pregnancy, creating the necessary conditions for the development of the ovum.

In women, testosterone is synthesized in small amounts by the ovaries, including the adrenal glands.

Male sex hormones

Testoterone is responsible for normal puberty and sexual function in men, the development of secondary sexual characteristics. Most of the testosterone is produced by the testes and only a small part is synthesized in the adrenal glands. An increase in testosterone levels is observed starting from puberty, remaining in high amounts and decreasing after 55-60 years.The maximum concentration of testosterone occurs in the morning, and decreases in the evening. Testosterone activates sexual desire (libido), spermatogenesis and potency in men. With a decrease in testosterone levels, pathological conditions develop associated with impaired potency, inability to conceive and the associated psychophysiological characteristics of sexual desire.

Pituitary hormones

In the pituitary gland, FSH and LH are synthesized, controlling the synthesis of sex hormones in the genitals themselves (in the ovary).

In the pituitary gland, prolactin is also synthesized, which is responsible for lactation. Accordingly, prolactin levels rise during pregnancy and later during breastfeeding.

As we can see, hormones are vital for the normal functioning of the whole organism as a whole. Therefore, in order to diagnose the state of the body and identify various disorders at the earliest stages, it is recommended to undergo regular hormonal examinations. The independent laboratory INVITRO offers patients a wide range of studies of the endocrine system: laboratory assessment of the functions of the thyroid gland, pancreas, gastrointestinal tract, pituitary gland and diagnosis of diabetes mellitus, etc….

(PDF) MORPHOLOGY OF THE ADRENAL AND THYROID IN THE RYNIC EVENING (NYCTALUS NOCTULA)

Scientific notes UO VGAVM, vol. 55, no. 3, 2019

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studies on the adrenal gland – its interrenal and suprarenal tissues, a number of

questions are still covered in the literature controversially, fragmentarily, and there is no answer to some questions

, since the adrenal gland is its structure is one of the most varying organs of vertebrates.

In terms of morphological studies on the histology of the thyroid and supra-

cheek glands, bats are of particular interest due to their heterothermality – in the

period of hibernation, their body temperature decreases to ambient temperature, reaching

0.1 ° C [15]. On the histology of the adrenal gland of this order of mammals, only fragmentary data are available in the literature

. According to D.S. Bansod, A.A. Dhamani [2], in males of the sacwing

Dobson, the thyroid gland consists of two lobes connected by an isthmus.The absolute

mass of the gland is minimal during the resting period (1.04 mg) and the maximum during the period of sexual intercourse –

multiplication (1.12 mg). The thyroid gland is pseudo-lobular, large-follicular type, due to which

the authors propose to divide the follicles of the organ into 3 types in this species of bats:

“A” (small) – 20-40 microns, “B” (medium) – 41- 70 microns and “C” (large) – 71-100 microns. However, in another work, scientists P.R. Chavhan, A.A. Dhamani [6] does not distinguish 3 types of follicles in the thyroid gland

in the male Dobson sackwing during the reproductive cycle.In addition,

C-cells are well expressed in the gland, which are present singly in the lining of each follicle, or in a group of 2-3 cells between the follicles of the gland.

When studying the morphology of the adrenal glands during estrus and pregnancy in females

Dobson’s pouch, P.R. Chavhan, A.A. Dhamani, S.D. Misar [5] found that organ

consists of cortical (73%) and medulla (27%), while the cortex is divided into typical three

zones – glomerular, fascicular and reticular.The absolute mass of the adrenal glands increases in the

period of pregnancy due to the growth of the bundle zone in the adrenal cortex. For this

species, the phenomenon of an additional adrenal gland is characteristic. At the ultrastructural level P.

Chavhan, A. Dhamani [4] revealed in this species of bats in the medulla of the adrenal gland 2 vi –

da cells – A and H cells.

Scientist A.A. Dhamani studied in detail the histological structure of the adrenal gland in a rare species of Indian bats

– the Ceylon leaf bats [8].It has been established that the absolute mass of

of the adrenal gland increases with age, primarily due to an increase in the fascicular and

reticular zones of the cortex, while the size of the adrenal medulla does not have any sharp age-related changes. A program and

photographing was carried out color images (resolution 1400 x 900 pixels).In addition to

, photographing was carried out on a Celestron digital microscope with a PentaView LCD screen, model # 44348

, followed by analysis of color images (resolution

1920 by 1080 pixels). All digital data obtained during the research,

were processed statistically using the Microsoft Excel computer program. A total of

5 sexually mature individuals were examined.

Research results.As a result of morphological studies of the adrenal gland, it was found that the shape of the right organ is in the form of a pyramid, and the shape of the left organ is more often in the form of a crescent. The adrenal gland is brown in color and has an elastic consistency.

The adrenal gland of rufous nocturnal is covered from the surface with a well-defined capsule of

dense loose connective tissue, 28.34 ± 4.08 µm thick. From the capsule into the cortex

in the form of rays, connective tissue layers enter, of an insignificant thickness,

.For the adrenal gland of red nocturnal, the glomerular structure of the outer cortex is typical.

The cytoplasm of the cells of the glomerular zone has an openwork appearance. The cells of this zone have large

rounded nuclei, with a volume of 94.13 ± 3.09 μm3, with one nucleolus and numerous lumps of

chromatin, which give a variegated nucleus, and also polygonal cells are found –

we with oval nuclei located in the center of the cell and homogeneously stained. The thickness of the glomerular zone of the adrenal cortex

is 34.01 ± 3.99 microns.

The bundle zone contains typical radially oriented strands of cells, between which

sometimes dilated capillaries are found. The cells of the fascicular zone have significant vacuolization

, their nuclei are often located in the form of lanes, and the cytoplasm is foamy, not

has an openwork structure, like the glomerular zone. The volume of the nuclei of the cells of the bundle zone is

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