Primary adrenal insufficiency occurs when there is a pathology affecting the adrenal gland itself. The decreasing or suppressed adrenal function may be masked until stress or illness triggers an adrenal crisis.Īdrenal insufficiency can be classified into primary, secondary, and tertiary causes. Due to its vague symptoms and varying degree of clinical presentation, a clinician must maintain a high level of suspicion for this disease. Primary adrenal insufficiency is also known as autoimmune adrenalitis or Addison disease.Īdrenal insufficiency ranges from mild nonspecific symptoms to life-threatening shock conditions. Destruction or dysfunction of the adrenal cortex mainly causes glucocorticoid and mineralocorticoid deficiency. The cortex is responsible for producing glucocorticoids, mineralocorticoids, and androgens. The adrenal cortex produces hormones necessary for normal body functioning deficiency of these hormones results in adrenal insufficiency. Patients with persisting suggestive symptoms and/or a clinical history of higher risk for adrenal insufficiency deserve careful subsequent reassessments.The adrenal gland is made up of two parts, the cortex and the medulla. Therefore, clinical judgment and follow-up are crucial for the assessment of corticotropin deficiency. At the same time, diagnosis is complex as no single test has sufficient sensitivity to identify all patients with SAI.
It is essential to perform validated diagnostic procedures in order to promptly diagnose hypoadrenalism so as to prevent an adrenal crisis. Finally, long-term administration of exogenous glucocorticoids can determine secondary and/or tertiary hypoadrenalism acting at the hypothalamic level and leading to prolonged suppression of the hypothalamic-pituitary-adrenal axis. Less commonly, SAI is due to nontumoral disorders including infiltrative lesions, infective processes, vascular alterations, traumatic brain injury, empty sella or genetic disorders.
The most frequent endogenous cause of secondary adrenal insufficiency (SAI) is a tumor of the hypothalamic-pituitary region, usually associated with panhypopituitarism secondary to tumor growth or to its treatment with surgery or irradiation. Corticotropin deficiency can be isolated or more frequently occur in association with other pituitary hormones deficiencies.
Adrenal failure secondary to hypothalamic-pituitary disease is a common although underestimated and underdiagnosed condition, with serious consequences.
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