Adrenal Anatomy:
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%
Diagnostic Algorithm:
Adrenocorticotropic Hormone Deficiency (secondary cortisol deficiency):
Etiology:
- Exogenous glucocorticoid use
- 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