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14-September-2008 18:02:45 - insufficiency Adrenal insufficiency Classification and external resources Adrenal gland ICD-10 E27.1-E27.4 ICD-9 255.4 eMedicine emerg/16 MeSH D000309 Adrenal insufficiency is a condition in which the adrenal glands, located above the kidneys, do not produce adequate amounts of steroid hormones chemicals produced by the body that regulate organ function, primarily cortisol, but may also include impaired aldosterone production a mineralcorticoid which regulates sodium, potassium and water retention.12 Craving for salt or salty foods due to the urinary losses of sodium is common.3 Addison's disease is the worst degree of adrenal insufficiency, which if not treated, severe abdominal pains, diarrhea, vomiting, profound muscle weakness and fatigue, extremely low blood pressure, weight loss, kidney failure, changes in mood and personality and shock may occur adrenal crisis.4 An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, or severe infection. Death may quickly follow.4. Adrenal insufficiency can also occur when the hypothalamus or the pituitary gland, both located at the base of the skull, doesn't make adequate amounts of the hormones that assist in regulating adrenal function.156 This is called secondary adrenal insufficiency and is caused by lack of production of ACTH in the pituitary or lack of CRH in the hypothalamus.7 Contents 1 Types 2 Causes 3 Symptoms 4 Diagnosis 5 Treatment 6 Simple diagnostic chart 7 See also 8 External links 9 References Types There are two major types of adrenal insufficiency. Primary adrenal insufficiency is due to impairment of the adrenal glands. The most common subtype is called idiopathic or unknown cause of adrenal insufficiency. Some are due to an autoimmune disease called Addison's disease or autoimmune adrenalitis. Other cases are due to congenital adrenal hyperplasia or an adenoma tumor of the adrenal gland. Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus.8 These can be due to a form of cancer: a pituitary microadenoma, a pituitary macroadenoma, or a hypothalamic tumor; Sheehan's syndrome, which is associated with impairment of only the pituitary gland; or a past head injury. Causes Autoimmune may be part of a polyglandular autoimmune disorder which can include type I Diabetes Mellitus, autoimmune thyroid disease also known as autoimmune thyroiditis, Hashimoto's thyroiditis and Hashimoto's disease9 Adrenoleukodystrophy10 Discontinuing corticosteroid therapy without tapering the dosage severe adrenal suppression with ACTH suppression Illness or any other forms of stress this is termed critical illness-related corticosteroid insufficiency kidney injury environmental genetics Head injury Radiation Surgery infections eg, meningitis congenital hypopituitarism congential hypoadrenalism Symptoms The person may show symptoms of hypoglycemia, dehydration, weight loss and disorientation. They may experience weakness, tiredness, dizziness, low blood pressure that falls further when standing orthostatic hypotension, muscle aches, nausea, vomiting, and diarrhea. These problems may develop gradually and insidiously. Addison's can present with tanning of the skin which may be patchy or even all over the body and in some cases a person with light skin can look so dark people mistake them for being from another country. Characteristic sites of tanning are skin creases e.g. of the hands and the inside of the cheek buccal mucosa. Goitre and vitiligo may also be present.4 Diagnosis If the person is in adrenal crisis, the ACTH stimulation test may be given. If not in crisis, cortisol, ACTH, aldosterone, renin, potassium and sodium are tested from a blood sample before the decision is made if the ACTH stimulation test needs to be performed. X-rays or CT of the adrenals may also be done.1 Treatment Adrenal crisis Intravenous fluids4 Intravenous steroid Solu-Cortef or Solumedrol, later hydrocortisone, prednisone or methylpredisolone tablets4 Rest Cortisol deficiency primary and secondary Adrenal cortical extract usually in the form of a supplement, non prescription in the United States Hydrocortisone Cortef between 20 and 35 mg4 Prednisone Deltasone 7 1/2 mg Prednisolone Delta-Cortef 7 1/2 mg Methylprednisolone Medrol 6 mg Dexamethasone Decadron 1/4 mg, some doctors prescribe 1/2 to 1 mg, but those doses tend to cause side effects resembling Cushing's disease Mineralcorticoid deficiency low aldosterone Fludrocortisone Florinef To balance sodium, potassium and increase water retention4 Simple diagnostic chart Source of pathology CRH ACTH DHEA DHEA-S cortisol aldosterone renin Na K Causes5 hypothalamus tertiary1 low low low low low3 low low low low tumor of the hypothalamus adenoma, antibodies, environment, head injury pituitary secondary high2 low low low low3 low low low low tumor of the pituitary adenoma, antibodies, environment, head injury, surgical removal6, Sheehan's syndrome adrenal glands primary7 high high high high low4 low high low high tumor of the adrenal adenoma, stress, antibodies, environment, Addison's, injury, surgical removal 1 Automatically includes diagnosis of secondary hypopituitarism 2 Only if CRH production in the hypothalamus is intact 3 Value doubles or more in stimulation 4 Value less than doubles in stimulation 5 Most common, doesn't include all possible causes 6 Usually because of very large tumor macroadenoma 7 Includes Addison's disease See also Cushing's syndrome, over production of cortisol Insulin tolerance test, another test used to identify sub-types of adrenal insufficiency Hypoadrenia, describes the precursor to adrenal insufficiency, adrenal fatigue External links Penn State University - Adrenal insufficiency CAH - Congenital adrenal hyperplasia References ^ a b c Eileen K. Corrigan 2007. Adrenal Insufficiency Secondary Addison's or Addison's Disease. NIH Publication No. 90-3054. ^ MeSH Adrenal+Insufficiency ^ Ten S, New M, Maclaren N 2001. Clinical review 130: Addison's disease 2001. J. Clin. Endocrinol. Metab. 86 7: 2909-22. PMID 12899587. ^ a b c d e f g Ashley B. Grossman, MD 2007. Addison's Disease. Adrenal Gland Disorders. ^ Brender E, Lynm C, Glass RM 2005. JAMA patient page. Adrenal insufficiency. JAMA 294 19: 2528. doi:10.1001/jama.294.19.2528. PMID 16287965. ^ Dorlands Medical Dictionary:adrenal insufficiency. ^ Secondary Adrenal Insufficiency: Adrenal Disorders: Merck Manual Professional. ^ hypopituitary 2006. ^ Thomas A Wilson, MD 2007. Adrenal Insufficiency. Adrenal Gland Disorders. ^ Thomas A Wilson, MD 1999. Adrenoleukodystrophy. v d e Endocrine pathology: endocrine diseases E00-35, 240-259 Pancreas/ glucose metabolism Diabetes mellitus types: type 1, type 2, MODY, complications: coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome - insulin receptor Rabson-Mendenhall syndrome - Insulin resistance Hypothalamic/ pituitary axes Pituitary Hyperpituitarism Acromegaly, Hyperprolactinaemia, SIADH Hypopituitarism Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus Adiposogenital dystrophy - Empty sella syndrome - Pituitary apoplexy - ACTH deficiency Thyroid Hypothyroidism Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema Hyperthyroidism Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii Thyroiditis De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis Euthyroid sick syndrome - Thyroid hormone resistance - Thyroid nodule Parathyroid Hypoparathyroidism Pseudohypoparathyroidism - Hyperparathyroidism Primary, Secondary, Tertiary Adrenal Adrenocortical hyperfunction: Cushing's syndrome Nelson's syndrome, Pseudo-Cushing's syndrome - Hyperaldosteronism Conn syndrome, Bartter syndrome CAH Lipoid, 3β, 11β, 17α, 21α Adrenal insufficiency Addison's disease, Waterhouse-Friderichsen syndrome - Hypoaldosteronism Gonads ovarian Polycystic ovary syndrome, Premature ovarian failure testicular 5-alpha-reductase deficiency, 17-beta-hydroxysteroid dehydrogenase deficiency general Hypogonadism, Delayed puberty, Precocious puberty Other Androgen insensitivity syndrome - Autoimmune polyendocrine syndrome - Carcinoid syndrome - Gigantism - Short stature Laron syndrome, Psychogenic dwarfism - Multiple endocrine neoplasia 1, 2 - Progeria - Woodhouse-Sakati syndrome - thymus Abscess of thymus, Thymus hyperplasia see also congenital, neoplasia v d e Corticosteroids - glucocorticoid/receptor and mineralocorticoid/receptor A07EA, C05AA, D07, D10AA, H02, R01AD, R03BA, S01BA, S02B, and S03B Endogenous in CAPS Mineralocorticoids ALDOSTERONE, Deoxycorticosterone, Fludrocortisone Glucocorticoids CORTISONE, HYDROCORTISONE/CORTISOL, DESOXYCORTONE, Beclometasone, Betamethasone, Budesonide, Ciclesonide, Cloprednol, Cortivazol, Deflazacort, Dexamethasone, Fluticasone, Flunisolide, Hydrocortisone aceponate, Hydrocortisone buteprate, Hydrocortisone butyrate, Meprednisone, Methylprednisolone, Methylprednisolone aceponate, Mometasone furoate, Paramethasone, Prednicarbate, Prednisolone, Prednisone, Prednylidene, Rimexolone, Triamcinolone Other/ungrouped corticosteroids Alclometasone, Amcinonide, Clobetasol, Clobetasone, Clocortolone, Desonide, Desoximetasone, Diflorasone, Diflucortolone, Difluprednate, Fluclorolone, Fludroxycortide, Flumetasone, Fluocinolone acetonide, Fluocinonide, Fluocortin, Fluocortolone, Fluorometholone, Fluperolone, Fluprednidene, Formocortal, Halcinonide, Halometasone, Loteprednol, Medrysone, Tixocortol, Ulobetasol Aldosterone antagonists Spironolactone, Eplerenone, Potassium canrenoate, Canrenone Retrieved from http://en..org/wiki/Adrenal_insufficiency Categories: Endocrinology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Español Français עברית This page was last modified on 6 September 2008, at 16:54
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