Aldosterone and Hormone Replacement Therapy

Aldosterone falls in the class of hormone called mineralocorticoids, produces by the adrenal glands and is found near the kidneys. It sustains blood pressure, water and salt balance within the body. This procedure is assisting the kidneys to preserve sodium and excrete potassium in order to maintain a balance. If Aldosterone production falls, there isn’t enough regulation of salt and water balance (as aldosterone is being lost through urination) triggering blood pressure and blood volume to decline as a result of the kidneys not functioning properly. If body is in need of salt, water is not retained and adrenals release more Aldosterone and salt is reabsorbed from the tubule.

Addison’s disease is a hormonal disorder that affects all age groups, both male and female. The disease is categorised depending on the individual, this may include; weight, low blood pressure darkening of skin etc. When an insufficient amount of the hormone, cortisol and some cases the hormone aldosterone is being produced from the adrenal glands, it causes the Addison’s disease to occur. Cortisol helps maintain blood pressure and cardiovascular function, slows immune systems inflammatory response, breaks down sugar for energy (balancing insulin levels) and helps regulate metabolism of proteins, carbohydrates and fats. The brains hypothalamus glands control and accurately balance the amounts of cortisol needed.

Symptoms of Addison’s disease are slow and progressive but if left untreated may become fatal. Worsening fatigue and muscle weakness, loss of appetite and weight loss are characteristic for this illness. In 50% of cases nausea, vomiting and diarrhoea are present. Skin changes are common – this is when certain areas of the skin (exposed or non-exposed) darken, most common on pressure points. Irritability and depression, salty food cravings, low blood sugar (usually in children) and irregular or no periods, for women, may occur. Addison crisis is when symptoms are noticed until a significant incident occurs. This then has symptoms of lower back, abdomen, or leg pain; severe vomiting and diarrhoea followed by dehydration, low blood pressure and loss of consciousness, if left this may result in a fatality due to heart failure.

Adrenal Insufficiency is treated orally through tablets taken once to three times per day depending on the individual’s case. The treatment is simply replacing the hormones that aren’t being produced. Cortisol is replaced with a synthetic glucocorticoid tablet taken 1-3 times daily. In cases where aldosterone levels are also scarce; it is then substituted with oral doses of a mineralocorticoid, fludrocortisone acetate, taken once or twice daily. Usually the patient is required to increase their salt intake and dosages of medications will be altered between individual patients.

While undertaking treatment an Addisonian crisis may occur resulting in life threatening occurrences; low blood pressure, low blood glucose, and high levels of potassium. In order for rapid movement throughout therapy intravenous (injections into veins) of glucocorticoids and saline solution with dextrose are administered. The patient is able t take fluids and medications by mouth, the procedure is reduced though low levels of aldosterone may include oral doses of fludrocortisone acetate. If an individual in undertaking surgery, they are required to be awake throughout the procedure and are treated with intravenous glucocorticoids and saline. Treatment may be needed for the surgery. During an illness adjusted dosages of glucocorticoid is taken due to excess stress on the body. Once over the illness normal dosage may be regulated again, if the dosage isn’t altered during a sickness there may be an Addison crisis. Women who fall pregnant and suffer from Addison’s disease may need to also alter their medications depending on the individual. During delivery of the baby, similar treatment is applied as to surgery and after there is monitoring of what the dosage requirements need to change to.

In having the hormone replacement therapy, there are long-term and short-term benefits. In the long term estrogen levels will be higher than average reducing vaginal dryness and urethritis. Preventions of fractures, heart disease, colon cancer, or dementia and most commonly reduce breast and uterine cancer.

The prognosis for people with Addison’s disease can be uncertain. If untreated, it will be fatal, if diagnosed it requires a lifelong treatment. In some cases there is an increased chance of a ‘premature death’. In most cases, with hormone replacement therapy, most people with Addison’s disease are able to live normal lives.

Bibliography

Brotherton J. & Mudie K. (2010), Heinemann Biology HSC, Pearson Australia. Victoria Corrigan E. K., Addison’s Disease, Retrieved December 19, 2012, from http://www.addisons.org.au/assoc/whatis.pdf National Heart, Lung, and Blood Institute (2013) Hormone Replacement Therapy. Retrieved December 19, 2012, from http://www.nlm.nih.gov/medlineplus/hormonereplacementtherapy.html NIDDK, Adrenal Insufficiency and Addison’s Disease. Retrieved January 4, 2013, from http://endocrine.niddk.nih.gov/pubs/addison/addison.aspx Barrett-Connora E. and Stuenkelb C. A., (2001), Hormone replacement therapy (HRT)— risks and benefits. Retrieved December 19, 2012, from, http://ije.oxfordjournals.org/content/30/3/423.full A.D.A.M., Inc., Addison’s disease. Retrieved December 19, 2012, from, http://www.nlm.nih.gov/medlineplus/ency/article/000378.htm

Renal Dialysis

Renal dialysis is “an artificial process in which wastes in the blood are removed by diffusion across a partially permeable membrane. Dialysis helps individuals whose kidney function is so impaired that products of metabolism, including urea, creatinine and uric acid, build up in the body instead of being eliminated.”In the United States, diabetes and high blood pressure are found to be the most common causes to end stage kidney disease (ESRD).

Symptoms of renal failure will vary between individual patients. Symptoms may be quite extensive depending on what the area is affected. Some may include; tiredness, lethargy, nausea, weakness, shortness of breath, and generalised swelling may occur.

The term ‘dialysis’ according to Dictionary.com is as follows; 1. The separation of particles in a liquid on the basis of differences in their ability to pass through a membrane. 2. The clinical purification of blood thus, as a substitute for the normal function of the kidney. The cleansing and filtering of your blood is called dialysis-excreting waste that your body doesn’t need and may cause harm, keeping a balance of chemicals.

The kidneys role in the body is to release waste and excess fluids out of the body, keeping it clean. This is achieved by the filtration of blood that flows through the kidneys. Waste products are removed from the metabolism area including urea, uric acid and creatinine through urination. The kidneys role is to regulate and concentrate the volume of body fluids. Renal dialysis takes place when the body is unable to perform this crucial function for itself.

Haemodialysis
Haemodialysis
Haemodialysis and Peritoneal dialysis are two form of treatment, both are different. Peritoneal Dialysis is when a tube is inserted into the peritoneal cavity and a sterile solution (that contains glucose) is passed through. A semi-permeable membrane, the peritoneal membrane, and the dialysate remain thee for sometime and helps absorb and drain out the waste products through the tube. Osmosis takes place in the unfliteration process of the blood. Haemodialysis is where blood is pumped directly into the blood compartment of the dialyzer that helps filter the blood. As the blood flows through the machine the dialysis solution removes waste and water and filters the blood. After this process is complete the blood is then able to flow back into the body. Haemodialysis requires the patient to unable under strict dietary regulations whereas PD has more choice in their diet.