AM Report 1/25/17: Secondary Adrenal Deficiency secondary to Megace

Adrenal Anatomy:

1818_the_adrenal_glands

Primary Adrenal Failure (Addison’s Disease):

  • Failure of the adrenal cortex
  • Prevalence 10-15/100,000 persons
  • Etiology – Autoimmune adenitis ~70-80%; 2/3 will have at least one other autoimmune endocrine disorder; TB infiltration ~ 7-20%

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Diagnostic Algorithm:

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Adrenocorticotropic Hormone Deficiency (secondary cortisol deficiency):

Etiology:

  1. Exogenous glucocorticoid use
  2. Damage to the pituitary gland/stock
  • Reminder of intact adrenal cortex will be a normal renin/aldosterone ratio
  • Less risk for hypotension, hyponatremi, adrenal crisis than primary failure
  • No hyperpigementation due to lack of hypersecrtion of ACTH

Multiple case reports of megase induced secondary adrenal insufficency

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