Adrenal gland and paraganglia
Secondary adrenocortical insufficiency
Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 6 February 2013, last major update February 2005
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.
● Caused by any disorder of pituitary gland which decreases ACTH production and causes adrenal cortical atrophy
● Causes: pituitary macroadenoma, craniopharyngioma, tuberculosis or other infections, sarcoidosis, lymphocytic hypophysitis, head trauma, aneurysms, postpartum pituitary necrosis (Sheehan’s syndrome), pituitary apoplexy or metastases; also mutations in pro-opiomelanocortin gene
● Tertiary adrenocortical insufficiency: due to disorders of hypothalamus reducing release of corticotropin releasing hormone (CRH); some include this within secondary adrenocortical insufficiency
● Similar atrophic changes are caused by exogenous steroids, which also decrease ACTH production
● No hyperpigmentation since ACTH levels are low
● Laboratory: serum aldosterone, sodium and potassium levels are usually normal, since they are controlled by renin-angiotensin axis, which is not under the control of ACTH; androgens and cortisol levels are low since their production is influenced by ACTH, although androgens are less affected in males since they are also produced by testis; hypoglycemia is more common than with primary adrenal insufficiency
● May be associated with hypopituitarism
● Exogenous ACTH causes rise in serum cortisol levels
● May also need to replace other pituitary hormones
● Atrophic adrenal glands with retention of architecture, often fibrotic capsule, bright yellow (due to lipid accumulation) and prominent medulla
● Normal thickness of zona glomerulosa, thinner fasciculata and reticularis
● Usually no lymphoplasmacytic infiltration
End of Adrenal gland and paraganglia > Adrenal insufficiency > Secondary adrenocortical insufficiency
This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.
All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).