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Adrenal gland and paraganglia

Adrenal insufficiency

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

Gross description

● Atrophic adrenal glands with retention of architecture, often fibrotic capsule, bright yellow (due to lipid accumulation) and prominent medulla

Micro description

● Normal thickness of zona glomerulosa, thinner fasciculata and reticularis
● Usually no lymphoplasmacytic infiltration

End of Adrenal gland and paraganglia > Adrenal insufficiency > Secondary adrenocortical insufficiency

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