Overview Removal of a corticotropin-secreting tumor
Adrenal crisis Primary adrenal hypofunction or insufficiency (Addison's disease) originating within the adrenal gland and characterized by the Exhausted body stores of glucocorticoids in a patient with decreased adrenal secretion of mineralocorticoids, glucocorticoids, and androgens hypofunction after trauma, surgery, or other physiologic stress Secondary adrenal hypofunction due to a disorder outside the Incidence gland such Primary hypofunction as impaired pituitary secretion of corticotropin and characterized Primary adrenal hypofunction is relatively uncommon. by decreased glucocorticoid secretion This disorder can occur at any age and in both sexes. Autoimmune Addison's disease Adrenal crisis (addisonian crisis), a critical deficiency of mineralocorticoids and glucocorticoids generally following acute Autoimmune Addison's disease is most common in white females stress, (genetic sepsis, trauma, surgery, or the omission of steroid therapy in predisposition is likely). patients who This disorder is more common in patients with a familial have chronic adrenal insufficiency; a medical emergency that needs predisposition to immediate, vigorous treatment autoimmune endocrine diseases. Pathophysiology Age Factor Results from the partial or complete destruction of the adrenal Most people with Addison's disease are diagnosed in their cortex 20s to 40s. Manifests as a clinical syndrome in which the symptoms are Complications associated Hyperpyrexia with deficient production of the adrenocortical hormones cortisol, aldosterone, and androgen Psychotic reactions Results in high levels of corticotropin and corticotropin-releasing Deficient or excessive steroid treatment hormone Shock Secondary adrenal hypofunction: Involves all zones of the cortex, Profound hypoglycemia causing deficiencies of the adrenocortical hormones, glucocorticoids, Ultimate vascular collapse, renal shutdown, coma, and death (if androgens, untreated) and mineralocorticoids Assessment Cortisol deficiency: Causes decreased liver gluconeogenesis (the History formation of glucose from molecules that aren't carbohydrates); resulting low Synthetic steroid use, adrenal surgery, or recent infection blood Muscle weakness glucose levels can become dangerously low in patients who take insulin Fatigue routinely Weight loss Aldosterone deficiency: Causes increased renal sodium loss and Craving for salty food enhances potassium reabsorption Decreased tolerance for stress Hypotension due to sodium excretion GI disturbances Increased production of angiotensin II due to low plasma volume Dehydration and Amenorrhea (in women) arteriolar pressure Impotence (in men) Androgen deficiency: May decrease hair growth in axillary and Physical findings pubic areas (less noticeable in men) as well as on the extremities of women Poor coordination Causes Decreased axillary and pubic hair (in women) Primary hypofunction Bronze coloration of the skin and darkening of scars Autoimmune process in which circulating antibodies react Areas of vitiligo specifically against the adrenal tissue Increased pigmentation of mucous membranes Bilateral adrenalectomy Weak, irregular pulse Family history of autoimmune disease (may predispose the Hypotension patient to Addison's disease and other endocrinopathies) Hemorrhage into the adrenal gland Infection (histoplasmosis, cytomegalovirus) Neoplasm Tuberculosis (once the chief cause, now responsible for less than 20% of adult cases) Secondary hypofunction Abrupt withdrawal of long-term corticosteroid therapy