Adrenal hypofunction  Hypopituitarism

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