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Adrenal gland and paraganglia

Adrenal insufficiency

Primary acute adrenal insufficiency - general


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 6 February 2013, last major update February 2005
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

General
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● Often insidious in onset, patients may present in shock due to increased stress
● Patients usually live normal lives after diagnosis (depending on cause); may be at higher risk for heart failure, hypertension or osteopenia

Causes:
● Patients with chronic adrenal insufficiency (primary or secondary) and acute stress requiring immediate increase in steroids
● Rapid withdrawal of exogenous steroids (i.e. no taper) or failure to increase steroids with acute stress
● Massive adrenal hemorrhage destroying adrenal cortex due to anticoagulation, coagulopathy and newborns with physiologic deficiencies in prothrombin time
● Hypotension / shock that causes mild or massive corticomedullary necrosis, including Waterhouse-Friderichsen syndrome
● Infections that destroy substantial adrenal cortical tissue
● Amyloidosis
● Drugs, radiation
● Autoimmune disorders (autoimmune adrenalitis or polyglandular autoimmune syndromes)

Treatment
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● Glucocorticoids, mineralocorticoids and IV fluids
● In chronic patients, must give steroid boost during infections, prior to surgery or during pregnancy

Virtual slides
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Atrophy (caused not specified)

End of Adrenal gland and paraganglia > Adrenal insufficiency > Primary acute adrenal insufficiency - general


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