ADRENOCORTICAL HYPOFUNCTION

can lead to hypotension, shock and death if the

individual is stressed for example, by operation,

infection,trauma
is due most commonly to ACTH (corticotropin)
deficiency caused by suppression of adrenocortical
function following the use of systemic
corticosteroids (secondary hypoadrenocorticism);
occasionally by acquired adrenal disease (primary
hypoadrenocorticism); and rarely, by a congenital
defect in corticosteroid biosynthesis (congenital
adrenal hyperplasia)

Primary hypoadrenocorticism
(Addison disease)

caused by autoantibodies to the adrenal cortex,

leading to adrenocortical atrophy and failed

hormone secretion cortisol (hydrocortisone) and
aldosterone
Clinical features
Anorexia, nausea and vomiting
Hypotension
Skin and mucosal pigmentation
Weakness
Weight loss
lack of adrenocortical reserve makes patients
vulnerable

General management

Diagnosis of hypoadrenocorticism is confirmed by:

hypotension;
sometimes, low plasma sodium and raised
potassium; plasma glucose
assay (hypoglycaemia is common); and low plasma
cortisol levels and depressed cortisol responses to
ACTH stimulation
Serum should be tested for autoantibodies to
various tissues,
especially endocrine glands, and other
investigations may be needed, including radiography
or CT or MRI scans of the skull (for pituitary
abnormalities), chest (for tuberculosis) or abdomen
(for adrenal calcification suggestive of tuberculosis or

Dental aspects

CS should generally be avoided unless patient has

had corticosteroid cover

GA is obviously a matter for expert anaesthetist in
hospital
For dental surgery under LA, glucocorticoid dose
should be
doubled (up to 20 mg hydrocortisone) 1 hour before
surgery
After the procedure, the dose of oral medication is
doubled for 24 hours, and then normal dose is
reinstated
Brown or black pigmentation of mucosa is seen in
over 75% of patients with Addison disease

Secondary adrenocortical insufficiency

can be caused by corticosteroid therapy and ACTH

deficiency as a result of hypothalamic or pituitary

disease

ADRENOCORTICAL HYPERFUNCTION

Adrenocortical hyperfunction may lead to release of

excessive:
glucocorticoids (Cushing disease)
mineralocorticoids (Conn syndrome or
hyperaldosteronism)
androgens (congenital adrenal hyperplasia)

Cushing disease

General aspects
caused by excess glucocorticoid production by
adrenal
hyperplasia secondary to excess ACTH production
by pituitary basophil adenomas