Disease in which gradual atrophy of the adrenal cortex causes the adrenal glands to produce insufficient quantities of the steroid hydrocortisone while causing the pituitary gland to produce excess quantities of pituitary hormones. Most of the cortex tissue is destroyed by the time symptoms (including weakness, abnormal coloration, weight loss, and hypotension) appear. Hydrocortisone-replacement therapy is often successful, usually given with other hormones to stabilize sodium levels. More than half of cases are believed to be due to an autoimmune reaction (see autoimmune disease); the remainder are caused by destruction of the adrenal gland by granuloma (e.g., tuberculosis).
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Addison's disease is the worst degree of adrenal insufficiency, which if not treated, severe abdominal pains, diarrhea, vomiting, profound muscle weakness and fatigue, extremely low blood pressure, weight loss, kidney failure, changes in mood and personality and shock may occur (adrenal crisis). An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, or severe infection. Death may quickly follow..
Adrenal insufficiency can also occur when the hypothalamus or the pituitary gland, both located at the base of the skull, doesn't make adequate amounts of the hormones that assist in regulating adrenal function. This is called secondary adrenal insufficiency and is caused by lack of production of ACTH in the pituitary or lack of CRH in the hypothalamus.
Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus. These can be due to a form of cancer: a pituitary microadenoma, a pituitary macroadenoma, or a hypothalamic tumor; Sheehan's syndrome, which is associated with impairment of only the pituitary gland; or a past head injury.
|Source of pathology||CRH||ACTH||DHEA||DHEA-S||cortisol||aldosterone||renin||Na||K||Causes5|
|low||low||low||low||low3||low||low||low||low||tumor of the hypothalamus (adenoma), antibodies, environment, head injury|
|high2||low||low||low||low3||low||low||low||low||tumor of the pituitary (adenoma), antibodies, environment, head injury,|
surgical removal6, Sheehan's syndrome
|high||high||high||high||low4||low||high||low||high||tumor of the adrenal (adenoma), stress, antibodies, environment, Addison's, injury, surgical removal|
|1||Automatically includes diagnosis of secondary (hypopituitarism)|
|2||Only if CRH production in the hypothalamus is intact|
|3||Value doubles or more in stimulation|
|4||Value less than doubles in stimulation|
|5||Most common, doesn't include all possible causes|
|6||Usually because of very large tumor (macroadenoma)|
|7||Includes Addison's disease|
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