Adrenal Disease

25/07/2013 by admin | Endocrine

Adrenal failure:

  1. Failure of adrenals to produce steroids due to –
  2. Atrophy/destruction of adrenal gland = primary adrenal failure
    1. o Rare, 50/mil, autoimmune cause = Addison’s. Adrenal destruction associated with vitiligo, premature ovarian failure, and hypothyroidism. F>M, gradual onset of symptoms, worldwide tuberculosis destruction of adrenal glands is more common.
  3. Rarer causes: infection (HIV, fungi), invasion with cancer cells (lymphoma, breast, lung), haemorrhage (due to anti-coagulants, Waterhouse-Friedrichsen syndrome, meningococcal-induced DIC), infiltration (amyloid, sarcoid, haemochromatosis), congenital adrenal hyperplasia, drugs (ketoconazole).
  4. In primary adrenal failure, cortisol deficiency increases ACTH release, causing release of MSH – causing hyperpigmentation in buccal mucosa and on palms and soles. This does not occur in secondary adrenal failure as there is decreased ACTH!
  5. Inadequate adrenocorticotrophin hormone (ACTH) production = secondary adrenal failure! The most common cause linked to sudden steroid withdrawel.
    1. o Secondary causes: chronic steroid therapy supresses ACTH levels (v common), producing adrenal cortex atrophy – physical stress or over-quick steroid withdrawel = acute adrenal failure, pituitary failure. 
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