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 Metastatic cancer Pituitary failure
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.
Hereditary disorders Adrenal failure related to anitphospholipid syndrome in children
Physical Manifestations of adrenal insufficiency
Weakness/fatigue Headache Nausea Vomiting Hyperpigmentation Abdominal pain with diarrhea Sparse axillary hair Arthrlagias Unintentional weight loss