Adrenal Dysfunction:
HYPOfunction Adrenal insufficiency
Congenital adrenal hyperplasia,
Addisons disease, Infections, TB, Sepsis,
Disruption of HPA: Exogenous steroids,
ACTH secreting tumor
Low Cortisol
Low Aldosterone: Addisons disease
Addisons
Disease
Acute
Adrenal crisis
Aka
addisonian
crisis
HYPERfunction
- acquired
primary adrenal
insufficiency
Signs
Symptoms
Test
TX
causes
signs
Treatment:
IV fluids, IV hydrocortisone
Secondary
Adrenal
Insufficiency
TX
Adrenal Insufficiency
Primary:
Adrenal gland
Hyperpigmentation
Hyperkalemia
Elevated ACTH
Cushingsexcess cortisol
Secondary:
Hypothalamic-Pituitary
No hyperpigmentation
Normokalemia
Low ACTH: Can be low normal
Disease
Pituitary origin
Hypersecretion of ACTH from
pituitary
ACTH causes Cortisol
Syndrome
Origin is elsewhere:
Iatrogenic
Exogenous steroids
Adrenal tumor
ACTH secreting tumor
Small cell carcinoma
Hypersecretion of Cortisol
Signs and
symptoms
Metabolic
Complications
Hypercortisolism
Cortisol Excess
Round plethoric face (moon face)
Central obesity with thin limbs, Fat
pad buffalo hump, Mood/psychiatric
changes
Purple striae, Thin skin, easy bruising
Glucose intolerance (DM),
Osteoporosis
Poor wound healing, Hypertension,
Hyperandrogenism: hirsuitism/acne
> Calcium reabsorption from the
bone leads to: osteoporosis &
pathologic fractures
>Cortisol causes insulin resistance
hepatic gluconeogenesis and insulin
resistance.
leads to glucose intolerance and
diabetes mellitus
>Frequent infections & slow wound
healing
Suppressed inflammatory response
can mask severe infections
>Decreased ability to handle stress
Psych problems, mood swings
Screening Labs :
24hr urine cortisol
Serum Sodium
Serum Potassium
Glucose
>Plasma ACTH:
High in Pituitary/Ectopic source
Low in adrenal cause
Confirmation
TX
high potassium
Congenital
Adrenal
Hyperplasia
(CAH)
Pathogenesis
90% of affected
patients
Girl signs
Lab test
childhood (nonclassic)
TX