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1855, Inggris, Dr. Thomas Addisons Gambaran
klinis & Patologis kel. Adrenal, TBC >
Kel. Adrenal sepasang, piramid, diatas ginjal.
Cortex (luar) kortisol & aldosteron.
Medula ( dalam ) katekolamin.
Fungsi Kortisol :
metabolisme karbohidrat,prot, fat; fgs sistim
imun, sintesa dan efek katekolamin, kontraktilitas
jantung, penyembuhan luka, adanya stress,
integritas endotel, gula darah normal
Autoimmune Adrenalitis
Pituitary or metastatic tumor
Infection (TBC,fungal,bacterial,etc)
Craniopharyngioma
Adrenomyeloneuropathy
Pituitary surgery or radiation
Thrombosis
Sepsis
Hemorrhage
Lymphoma
Cancer
Long term glucocorticoid th/
Drug
Hypothalamic tumor
Abrupt Onset
Adrenal hemorrhage, necrosis, or
Sheehans Syndrome,
thrombosis or other kinds of sepsis,
Necrosis or bleeding into pituitary
in Coagulation disorders, or in
Anti phospolipid syndrome.
macroadenoma
Head trauma or lesion of pituitary stalk
Pituitary or adrenal surgery
Fisiologi :
Kortisol me pagi hari dan stres, me siang & malam hari
Signal (sitokin,tissue injury,hipotensi, sakit,hipoglikemia )
SSP Hipotalamus CRH Pituitary Ant. ACTH
adrenal kortisol,aldosteron dan androgen.
Patogenesa :
Insufisiensi adrenal primer lesi lokal / proses penyakit
rusak / disfungsi kel. Adrenal.
Insufisiensi adrenal sekunder sekresi kel.Pituitary ACTH .
(%)
100
100
92
86
75
33
31
16
16
12
6-13
Sign
Weight Loss
Hyperpigmentasi
Hypotension
Vitiligo
(%)
100
94
88-94
10-20
Laboratory
Electrolite disturbanc
Hyponatremia
Hyperkalemia
Hypercalcemia
Azotemia (Hipovol )
Anemia
Eosinofilia
(%)
92
88
64
6
55
40
17
Diagnosa :
- Gejala dan tanda klinis, hiperpigmentasi, Lab
(Kortisol,Kortikotropin,aldosteron tabel 3 ),
Auto antibodi, MRI, Biopsi, Radiolabelled
Recombinant human 21 Hydroxylase.
- Uji Stimulasi ACTH
- Uji Hipoglikemia yang distimulasi oleh Insulin.
Hormon Test
Normal Range
Measurement of basal
plasma cortisol between
8 and 9 a.m.
Plasma cortisol
6 24 g / dl
Interpretation Result
If plasma cortisol 3 g / dl
adrenal insuff. Confirmed; if
19 g / dl adrenal insufficiency
rule out.
Conventional cortico
tropin test
Measurement of basal
plasma cortisol and
corticotropin
Hormone test
Normal Range
Secondary adrenal
Insufficiency sus Pected.
Insulin induced
hypoglycemia
Plasma Glucose
<40 mg/dl, plas Ma cortisol 20
Plasma 11 deoxy
cortisol at 8 hours
7 g / dl,plasma
corticotropin >150pg/ml
Corticotropin
releasing hormon
adr-
test
Depends on dose,
time of administra
tion and spesies
human or bovine of
CRH
Interpretation Result
Basal or corticotro
pin stimulated plas
ma cortisol 18
g / dl
ciency.
Hormone Test
Corticotropin
releasing hor
mon test on
different day
Normal Range
Interpretation Result
Prolonged, exaggerat
ed plasma corticotro pin response, weak
plasma cortisol
respons in hypothala
mic disease.
No adrenal
insufficiency
Abnormal
ACTH Low
Secondary adrenal
insufficiency
Abnormal
ACTH Low
Primary adrenal
insufficiency
No cortisol respons
Primary adrenal
insufficiency
Pengobatan :
- Mengganti hormon yg tidak dihasilkan kel. Adrenal :
Glukokortikoid sintetik (hidrokortison) 25-37,5 mg/12 jam.
Mineralkortikoid (Fludokortison asetat) 0,05-0,2mg.
- Mengobati penyakit dasar.
- Suportif : dehidrasi, hipotensi, gangguan elektrolit,KGD normal
Adrenal Krisis :
- Hidrokortison IV : Bolus 100 mg 100-200 mg / 6 jam.
- Hipovolemia dan hiponatremia Isotonic saline.
- Suplemen glukosa.
Kesimpulan
- Penyakit Addison adalah penyakit yang sangat jarang.
- Penyebab terbanyak autoimun disease.
- Penyakit ini timbul karena kerusakan / disfungsi
kelenjar adrenal.
- Diagnosa berdasdarkan gejala dan tanda klinis, lab.
- Prinsip pengobatan mengganti hormon, mengatasi
- Penyakit dasar dan suportive.