adrenal 3

Question 1

adrenocortical insufficiency is either

Answer 1

• primary adrenal disease - primary hypoadrenalism

- decreased stimulation due to a deficiency in ACTH (usually pituitary hypofunction) - secondary hypoadrenalism

Question 2

three patterns of adrenocortical insofficiency

Answer 2

• primary acute adrenocortical insufficiency (adrenal crisis)
• primary chronic adrenocortical insufficiency (Addison disease)
• secondary adrenocortical insufficiency (usually chronic pituitary disease)

Question 3

Adenocortical insufficiency symptoms

Answer 3

hypoglycaemia, dehydration, weight loss and disorientation
weakness, tiredness, dizziness, orthostatic hypotension, cardiovascular collapse, muscle aches, nausea, vomiting, and diarrhoea
goitre and vitiligo may also be present

Question 4

Addison’s disease

Answer 4

can present with tanning of the skin that may be patchy

Question 5

primary acute adrenocortical insufficiency

Answer 5

may occur as a crisis in a patient which chronic adrenocortical insufficiency - any form of physiological stress that requires immediate increase in steroid output

may occur after rapid withdrawal (or failure to increase dose with stress) of exogenous corticosteroids - may have fever, syncope, convulsions, hypoglycaemia, hyponatraemia, severe vomiting and diarrhoea, confusion

may occur as a result of massive adrenal heamorrhage - eg. newborns or prolonged delivery, anticoagulants, disseminated intravascular coagulation, disseminated bacterial infection/sepsis

Question 6

primary chronic adrenocortical insufficiency - Addison’s disease

Answer 6

• uncommon disorder resulting from destruction of the adrenal cortex
• multiple aetiologies

Question 7

primary chronic adrenocortical insufficiency - Addisons disease presents with

Answer 7

fatigue, weakness, GI disturbances (nausea, diarrhoea, vomiting, constiptaion, abdominal pain), hypotension, myalgia, hyperpigmentation or vitiligo, hyponatraemia, hyperkalaemia

Question 8

usual aetiologies of primary chronic adrenocortical insuffieciency

Answer 8

• autoimmune adrenlitis - loss of cortical cells as well as a mononuclear inflammatory cell infiltrate
• tuberculosis (in areas where TB in endemic) - granulomatous inflammatory infiltrate
• metastatic malignancy (lung usually) - normal architecture obscured by infiltrating malignancy
• AIDS

Question 9

secondary adrenocortical insufficiency

Answer 9

any disorder of the hypothalamus or pituitary that reduces the output of ACTH
most common is prolonged administration of exogenous glucocorticoids
cortisol and androgens deficiency, but aldosterone is usually normal (controlled by renin/angiotensin), thus Na/K is normal