Adrenal Insufficieny

Question 1

what are the three etiologies of acute primary adrenal insufficiency?

Answer 1

massive hemorrhage of the adrenals, XS stress with chronic adrenal insuff. or sudden cessation of hydrocortisone

Question 2

what’s the name of adrenal hemorrhage in children? what is it associated with?

Answer 2

Waterhouse-Friederichsen syndrome; meningococcal sepsis or pseudomonas, streptococcus and staphylococcus

Question 3

what percentage of the gland must be destroyed for symptoms to occur? ACTH levels?

Answer 3

90%; normal

Question 4

what are the four main etiologies of Addison’s?

Answer 4

autoimmune - #1
infectious - TB, fungal with granuloma
AIDS - CMV, MAI, Kaposi
mets - bronchogenic carcinoma, breast carcinoma

Question 5

autoimmune addison’s features

Answer 5

autoantibodies to 21-hydroxylase and/or the ACTH receptor; lymphocytic infiltration of the adrenal gland
can be in constellation disease, APS (autoimmune polyendocrinopathy syndrome)

Question 6

clin features of addisons

Answer 6

progressive weakness and fatigue; hyperpigmentation (due to concomittant release of a melanotropic factor), GI problems (N/anorexia, weight loss), salt wasting, hyperK, hypoV, hypoT +/- hypoG due to impaired gluconeo; stress= adrenal crisis -> severe shock, coma, death

Question 7

clinical and etiology and histologic features of secondary adrenocortical insufficiency

Answer 7

tumor, infection, infarction; other hormones might be involved; atrophic adrenals, esp. ZF and ZR; symptoms are the same as primary except no hyperpigmentation and no aldo loss