SEARCH RESULTS FOR: Primary-Adrenal-Insufficiency

Primary-Adrenal-Insufficiency

Primary Adrenal Insufficiency: Clinical findings Infection (fungal or tuberculosis) Note: “Primary” refers to pathology in the gland that produces the functional hormone (in this case, the adrenal gland), as opposed to “secondary” or “tertiary” which refers to pathology in glands that indirectly control the primary gland. Bilateral adrenal Autoimmune damage (cancer, ↓ Androgen levels in women (in whom adrenal glands are the primary source) ↓ Libido ↓ Axillary and pubic hair Muscle/joint pain Anorexia, weight loss Abdominal pain, nausea, vomiting Diseases bleeding, etc) ↓ Androgen production from the zona reticularis ↓ Cortisol production from the zona fasciculata ↓ Serum cortisol Patients could present with many severe symptoms of adrenal insufficiency, e.g. low blood pressure refractory to fluid resuscitation Significant bilateral damage to the adrenal glands Entire adrenal cortex function impaired ↓ Serum levels of adrenal steroid hormones exert positive feedback effect on pituitary gland, ↑ pituitary gland’s production of adrenocorticotropic hormone (ACTH) ↑ Serum levels of ACTH The same gene that encodes ACTH also encodes melanocyte stimulating hormone (MSH) Coincidental ↑ in MSH production by the pituitary ↓ Serum DHEAS, testosterone and androstenedione Unknown mechanism(s) Malaise Adrenal Crisis ↓ Cortisol mediated gluconeogenesis and glycogenolysis ↑ Cortisol Releasing Hormone (CRH) from the hypothalamus Lack of cortisol-driven vasoconstriction of blood vesselsà↑ Vasodilation ↓ Blood pressure, postural dizziness Water follows sodiumà ↑ excretion of water ↓ Sodium resorbed from kidney tubulesà↑ Sodium excretion ↓ Potassium pumped into kidney tubules à↑ potassium retained in serum Hypoglycemia (↓ blood glucose) ↑↑ Antidiuretic hormone (ADH) release Kidneys reabsorb water à↑ total body water Hyponatremia (↓ serum sodium) ↑ Salt craving Hyperkalemia (high serum potassium level) ↓ Aldosterone production from the zona glomerulosa ↓ Serum aldosterone MSH triggers ↑ production of melanin by the melanocytes in skin ↓ Excretion of hydrogen ions from kidneys (See type IV RTA slide for full mechanism) Metabolic acidosis (low pH, low bicarbonate) ↓ Sodium channel and Na/K ATPase expression on principle cells of the kidney Hyperpigmentation of the skin and mucosal surfaces Authors: Jaye Platnich, Brooke Fallis, Yan Yu* Reviewers: Mark Elliott, Alexander Arnold, Hanan Bassyouni*, David Campbell* * MD at time of publication Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published November 13, 2013, updated October 1, 2021 on www.thecalgaryguide.com