-IBIS-1.5.0-
tx
endocrine system
hypoadrenalism
diagnoses

definition and etiology

definition:
Adrenal hypofunction, aka "Addison's disease".

etiology: The majority of cases are due to idiopathic atrophy of the adrenal cortex with the remainder being due to granulomatous lesions, inflammatory conditions, or neoplasms of the cortex.

signs and symptoms

The adrenal cortex produces androgens, glucocorticoids (e.g. cortisol), and mineralocorticoids (e.g. aldosterone).
• Increased excretion of Na and decreased excretion of K result in low blood concentrations of Na and Cl along with high serum K. These electrolyte changes produce increased water excretion, dehydration, increased plasma concentration, hypotension, and may lead to circulatory collapse.
• Diminished cortisol levels contribute to hypotension and disrupt protein, carbohydrate, and fat metabolism.
• Diminished conversion of protein to carbohydrates may lead to hypoglycemia.
Reduced cortisol levels lead to increased ACTH secretion causing increase in beta-lipotropin which has melanocyte producing activities and causes hyperpigmentation of the skin and mucous membranes.

signs and symptoms:
• weakness
• diminished resistance to infection, trauma, and stress
• decreased cardiac output capability
• orthostatic hypotension
• black freckles over the face, neck and shoulders
• bluish dark coloration of the areolae, lips, mouth, rectum, and vagina
• later stage symptoms include: weight loss, dehydration, hypotension and small heart size
• subclinical adrenal hypofunction may cause increased susceptibility to allergic responses; it is also characterized by vague symptoms like fatigue, dizziness, weight loss, abdominal pains, craving for salt, hypoglycemia

lab findings:
• low serum Na levels (<130 mEq/L)
• high serum K levels (>5 mEq/L)
• elevate BUN (>20 mg/100 ml)
• ratio serum Na: K (<30:1)
• low fasting blood sugar (<50 mg/100 ml)
• elevated hematocrit
• low WBC count
• relative lymphocytosis
• increased eosinophils

Specific testing for Addison's disease involves ACTH stimulation.

course and prognosis

• depends upon etiology; this condition is usually subacute and insidious, presenting simply as diminished energy or perhaps increased allergic response; it may go on for years without treatment; it is proposed that a high proportion of people in present-day society suffer from varying degrees of adrenal hypofunction because of the stress demands placed upon most individuals

differential diagnosis

• hypopituitarism
• nutritional deficiency
• food or environmental sensitivity or allergy
• malabsorption
• malignant disease
• psychogenic symptoms
• myopathies


footnotes