Adrenal Insufficiency
BY: GROUP 2
CARLOS
DAVID
GARCIA
LIWANAG
Adrenal Gland
Adrenal glands are two small glands
located superior to the kidneys.
adrenal medulla (inner part) produces
catecholamines.
adrenal cortex (outer part) secretes
three classes of steroid hormones:
mineralocorticoids, glucocorticoids and
androgens.
Case:
Summary of the Case
A 63-year old woman presented with increasing
darkening of the skin, dizziness, and easy fatiguability,
nausea with occasional vomiting and progressive weight
loss over eight months prior to presentation. Laboratory
investigations and results are as follows: plasma cortisol
was undetectable, plasma rennin and aldosterone
activity could not be estimated. HIV screening was
negative (HIV 1& 2). A computerised tomography scan
(CT) of the abdomen showed a non-enhancing oval
shaped left suprarenal mass with calcification.
Adrenal insufficiency
Adrenal insufficiency is a condition in
which the adrenal glands do not produce
adequate amounts of steroid hormones,
primarily cortisol.
Adrenal insufficiency results from a
primary adrenal disorder or is secondary
to ACTH deficiency.
Addisons disease, the common term for
primary adrenal insufficiency, occurs when
the adrenal glands are damaged and
cannot produce enough of the adrenal
hormone cortisol.
Secondary adrenal insufficiency occurs
when the pituitary gland to produce
enough adrenocorticotropin (ACTH), a
hormone that stimulates the adrenal
glands to produce the hormone cortisol.
Secondary adrenal insufficiency is much
more common than Addisons disease.
Hormonal results:
Low baseline cortisol levels and an
elevated ACTH greater than 200 pg/ml are
suggestive of adrenal primary insufficiency
Lower serum concentrations of ACTH and
cortisol are consistent with secondary
adrenal failure.
Signs and symptoms
major cause of adrenal
insufficiency.
Primary Adrenal Insufficiency
Autoimmune Disorders
Primary adrenal insufficiency occurs when at
least 90 percent of the adrenal cortex has
been destroyed.1 As a result, both cortisol
and aldosterone are often lacking.
Sometimes only the adrenal glands are
affected. Sometimes other endocrine glands
are affected as well, as in polyendocrine
deficiency syndrome.
Secondary Adrenal Insufficiency
Stoppage of Corticosteroid Medication
Corticosteroids are often prescribed to treat
inflammatory illnesses such as rheumatoid
arthritis, asthma, and ulcerative colitis
the prescription doses often cause higher
levels than those normally achieved by the
glucocorticoid hormones created by the
body.
Once the prescription doses of
corticosteroid are stopped, the adrenal
glands may be slow to restart their
production of the bodys glucocorticoids.
To give the adrenal glands time to regain
function and prevent adrenal
insufficiency
the difference between primary and secondary
adrenal insufficiency based on the following:
Serum aldosterone, serum ACTH/cortisol, signs
and symptoms
Primary Adrenal
Insufficiency
Secondary Adrenal
Insufficiency
Serum aldosterone
Low
Normal
serum ACTH/cortisol
High ACTH (>200
pg/ml), low baseline
cortisol (8 am)
Low
signs and symptoms
Hyperpigmentation
Hyperkalemia
Hypotension
Hyponatremia
Absence of
hyperpigmentation
Less severe
hypotension
. Different tests/ methods for
the diagnosis of adrenal
insufficiency.
ATCH stimulation test
Aka. Corsyntropin stimulation test
A synthetic stimulator of cortisol and aldosterone
secretion
It test the capacity of the adrenal gland to increase
hormone production in response to stimulation
It differentiates secondary adrenal insufficiency
from tertiary adrenal insufficiency
Specimen: Rando blood specimen
Normal value: cortisol >18-20ug/dL (500-550
nmol/L)
Insulin tolerance test
Gold standard for secondary and tertiary
hypocorticolism
Confirms borderline response to ACTH stimulation
test
Requirement: adequate hypoglycemia must be
attained (serum glucose <40mg/dL)
Oral dose: 0.05 U/kg of insulin
Blood collection: 120 minutes following insulin
administration
Measure serum cortisol and glucose
Normal value: increased plasma cortisol 18 g/L
or 20 g/L at any time during the test
Metyrapone test
A confirmatory test for secondary causes of
adrenal insufficiency
Oral dose of 30 mg of metyrapone administered
orally at midnight
It measures the ability of the pituitary gland to
respond to declining levels of circulating cortisol,
thereby secrete ACTH
Performed when ATCH stimulator test is gives
normal results
Blood collection: blood collected the following day
at 8am
Normal value: elevated plasma 11-deoxycortisol
>7 g/dL (200 nmol/L)
References:
Bishops Clinical Chemistry: Principles,
techniques and correlations
niddk.nih.gov/ Adrenal Insufficiency
