Transcript Adrenal-insufficiency

Adrenal Insufficiency
zona glomerulosa
(aldosterone)
zonae fasciculata and reticularis
(cortisol and adrenal androgens)
adrenal
cortex
fetal zone
(dehydroepiandrosterone)

androgens and estrogens.
Cortisol
(glucocorticoid hormone)
Adrenal
cortex
Aldosterone
(mineralocorticoid hormone)
Metabolism
(carbohydrates
proteins
fats)
anti-inflammation
react to stress
Balance of
Na+
K+
Adrenal Insufficiency
Primary
Addison’s Disease
Secondary
Primary Adrenal Insufficiency
(Addison’s Disease)
damaged
Renin-angiotensin II
(Kidneys)
Aldosterone
(mineralocorticoid hormone)
Adrenal
cortex
CRH
(hypothalamus)
ACTH
(Pituitary)
Cortisol
(glucocorticoid hormone)
Secondary Adrenal Insufficiency
Adrenal
cortex
CRH
(hypothalamus)
ACTH
(Pituitary)
Cortisol
(glucocorticoid hormone)
Prevalence:
1-4 people per 100,000 in the US
in all ages
affects both males and females equally
Etiology
primary adrenal insufficiency
adrenal damage
70% :
autoimmune process.
30%:
tuberculosis (a common cause where tuberculosis is more
prevalent)
other bacterial, viral and fungal infections
adrenal hemorrhage
the spread of cancer into the adrenal glands.
genetic abnormality of the adrenal glands(rarely)
Etiology
Secondary adrenal insufficiency
hypothalamus diesease
pituitary disease
Lack of ACTH receptors on adrenal cortex
Signs and Symptoms:
Abdominal pain
Decreased body hair
Dehydration (only in Addison’s disease)
Diarrhea or Constipation
Dizziness and Fainting
Fatigue
Hyperpigmentation (only in Addison’s disease - dark patches of skin, especially in
the folds of the skin. Sometime black freckles on the forehead, and face and/or
discoloration around areas such as the nipples, lips, and rectum)
Joint and muscle aches
Low blood pressure
Low blood sugar (hypoglycemia)
Muscle weakness
Salt craving (only in Addison’s disease)
Vomiting
Weight loss
Tests
Diagnosis
Primary
Secondary
(Addison’s disease)
(Hypopituitarism)
Cortisol
Low
Low
Cortisol
Low
High
Aldosterone
Low
Normal
ACTH
High
Low
Renin
High
Normal
(ACTH stimulation test)
Tests
Determine Severity and monitor the treatment
Electrolytes (Sodium, Potassium, Chloride and Carbon dioxide)
With Addison’s disease the sodium, chloride, and carbon dioxide levels are
often low, while the potassium level may be very high.
BUN and Creatinine: to monitor kidney function.
Glucose: may be very low during an addisonian crisis.
Tests
Occasionally used tests
Insulin-induced hypoglycemia test. Glucose and cortisol levels are
measured at predetermined intervals after an injection of insulin is used to
stress the pituitary glands. In healthy people, blood glucose levels fall and
cortisol concentrations increase. In those with adrenal insufficiency cortisol
levels will remain low and glucose levels will fall then recover slowly.
21-hydroxylase autoantibodies. ordered when autoimmune Addison’s
disease is suspected. They are considered a good marker of autoimmune
Addison's disease but are not widely used at this time.
Tests
Non-laboratory
X-rays: calcification on the adrenal cortex that may be
due to a tuberculosis infection.
CT or MRI: size and shape of the adrenal glands and the
pituitary. (The adrenal glands can be enlarged with infections
and cancers. With autoimmune diseases and secondary adrenal
insufficiency the adrenal glands are often normal or small in
size.)
Treatment
There is usually no cure for primary adrenal insufficiency,
unless the cause is an infection, in which case, patients may
regain some adrenal function. However, even when damage to
the adrenal cortex is extensive and permanent, persons with
Addison’s disease should be able to live healthy, relatively
normal lives by replacing the missing hormones and observing a
few precautions.
In the case of secondary adrenal insufficiency, it is very rare for
a patient to respond to treatment if the cause is pituitary damage
or disease. However, if the underlying condition can be
resolved, such as if the insufficiency is due to corticosteroid
therapy, cortisol production may eventually resume.