Explain Hypothalmus-Pituitary Adrenal Axis
Hypothalamus synthesizes and releases CRH (corticotropin releasing hormone)
Anterior pituitary synthesis and releases ACTH (adrenal corticotropic hormone)
Adrenal Cortex synthesizes and releases cortisol and corticosterone
Destruction of adrenal cortices result in a deficiency of cortisol, androgens, and aldosterone.
Etiology of Addison's Disease.
Autoimmune destruction of adrenal gland
Bilateral adrenal hemorrhage or infarction
Primary Adrenal Insufficiency
Inability of adrenal cortex to synthesize and secrete sufficient amounts of glucocorticoid and mineral corticoid hormones - cortisol & aldosterone
Secondary Adrenal Insufficiency.
Insufficient adrenocorticotropin hormone (ACTH) and corticotropin-releasing hormone secretion from hypothalamus and pituitary glands.
Acute Adrenal Crisis
Any form of AI can evolve into crisis
Often precipitated by trauma, surgery, or infections
Can be caused by sudden withdrawal of adrenocortical hormone in chronic AI patient
Results in deficient mineralocorticoids & glucocorticoids
Critical-Illness Related Adrenal Insufficiency.
Cortisol production insufficient to control inflammatory response or meet metabolic demand
Risk factors for Adrenal insufficiency.
Adrenal failure related to anitphospholipid syndrome in children
Physical Manifestations of adrenal insufficiency
Abdominal pain with diarrhea
Sparse axillary hair
Unintentional weight loss
Laboratory Findings in adrenal insufficiency.
Low aldosterone levels
Elevated erythrocyte sedimentation rate (ESR)
Low plasma cortisol levels
Diagnostic findings in adrenal insufficiency
Adrenal imaging (CT/MRI)
Brain imaging (MRI)
Cosyntropin test (synthetic ACTH)
Management of Adrenal Insufficiency.
Glucocorticoid and mineralcorticoid replacement
Consider broad spectrum antibiotics
Treat underlying cause