Adrenal atrophy
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Pathophysiology
Primary adrenal insufficiency
Primary adrenal insufficiency, which can be acute or chronic, may be caused by the anatomic destruction of the gland. This destruction can have various causes, including tuberculosis (TB) or fungal infection, other diseases infiltrating the adrenal glands, and hemorrhage. However, the most frequent cause is idiopathic atrophy, which is probably autoimmune in origin.
Primary adrenal insufficiency also may be caused by metabolic failure (eg, insufficient hormone production). This failure may be a result of congenital adrenal hyperplasia, enzyme inhibitors (e.g., metyrapone), or cytotoxic agents (e.g., mitotane).
Primary adrenocortical insufficiency is rare and it occurs at any age. The male-to-female ratio is 1:1.
Secondary adrenal insufficiency
Secondary adrenal insufficiency may be caused by hypopituitarism due to hypothalamic-pituitary disease, or it may result from suppression of the hypothalamic-pituitary axis by exogenous steroids or endogenous steroids (i.e., tumor).
Secondary adrenocortical insufficiency is relatively common. Extensive therapeutic use of steroids has greatly contributed to increased incidence.
Acute adrenocortical insufficiency
Adrenal crisis may result from an acute exacerbation of chronic insufficiency, usually caused by sepsis or surgical stress. Acute adrenal insufficiency also can be caused by adrenal hemorrhage (e.g., usually septicemia-induced Waterhouse-Friderichsen syndrome - fulminant meningococcemia) and anticoagulation complications.
Steroid withdrawal is the most common cause of acute adrenocortical insufficiency, and it almost exclusively causes a glucocorticoid deficiency.
Symptoms
- Fatigue
- Weakness
- Depression
- Frustration
- Premenstrual tension
- Nervousness
- Scanty perspiration
- Inability to concentrate
- Lightheadedness
- Sweet cravings
- Irritability
- Insomnia
- Allergies
- Headaches
Pathological Findings
 SCHILDER'S DISEASE, ADRENAL ATROPHY Image courtesy of Professor Peter Anderson DVM PhD © PEIR University of Alabama at Birmingham, Department of Pathology |
 SCHILDER'S DISEASE, ADRENAL ATROPHY, KIDNEY AND AORTA Image courtesy of Professor Peter Anderson DVM PhD © PEIR, University of Alabama at Birmingham, Department of Pathology |
 ADDISON'S DISEASE, ADRENAL ATROPHY Image courtesy of Professor Peter Anderson DVM PhD © PEIR, University of Alabama at Birmingham, Department of Pathology |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
