Adrenal gland & paraganglia
Adrenal insufficiency
Secondary adrenal insufficiency
Author: Nat Pernick, M.D.
Topic Completed: 1 February 2005
Minor changes: 18 December 2020
Copyright: 2002-2019, PathologyOutlines.com, Inc.
PubMed Search: Secondary adrenocortical insufficiency
Table of Contents
Definition / general | Treatment | Gross description | Microscopic (histologic) descriptionCite this page: Pernick N. Secondary adrenal insufficiency. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalsecondary.html. Accessed December 4th, 2021.
Definition / general
- 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 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
Treatment
- 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
Microscopic (histologic) description
- Normal thickness of zona glomerulosa, thinner fasciculata and reticularis
- Usually no lymphoplasmacytic infiltration
