Primary And Secondary Adrenal Insufficiency

Cortisol plays a major role in the development of this disorder. It is secreted by the adrenal gland, located above the kidneys, in a precise sequence of events. The hypothalamus directs corticotropin-releasing hormone(CRH) to the pituitary gland.1 CRH causes the pituitary to release adrenocorticotropin hormone(ACTH) activate the adrenal glands.1 The adrenal glands pick up the ACTH, they reciprocate by releasing cortisol in the bloodstream.1 Cortisol helps with quite a few of your body functions. Some of these functions are stress response, balancing the effects of insulin, reducing the immune system’s inflammatory response, regulating

According to http://www.webmd.com/, “the adrenal glands don't make enough of a hormone called cortisol, or less often, a related hormone called aldosterone.” That's why doctors sometimes call the illness ''chronic adrenal insufficiency,'' or hypocortisolism. “most important function is to help the body respond to stress. It also helps regulate your body's use of protein, carbohydrates, and fat; helps maintain blood pressure and cardiovascular function; and controls inflammation.” Aldosterone helps your kidneys regulate the amount of salt and water in your body -- the main way you regulate blood volume and keep your blood pressure under control. When aldosterone levels drop too low, your kidneys cannot keep your salt and water levels in balance. This makes your blood pressure drop. “There are two forms of Addison's disease. If the problem is with the adrenal glands themselves, it's called primary adrenal insufficiency. If the adrenal glands are affected by a problem starting somewhere else -- such as the pituitary gland -- it's called secondary adrenal

     Diagnosing Addison’s disease is most accurately done with biochemical laboratory tests which consist of an injection of ACTH then monitoring the ACTH output in a patient’s urine and/or the levels of ACTH in the patient’s blood to see how the person’s body reacts to the injection. Physicians can also detect Addison’s disease by an insulin-induced hypoglycemia test, which monitors how the adrenal glands, the pituitary glands, and the hypothalamus respond to stress. In this test the patient’s levels of blood glucose and cortisol are measured over an hour and a half following an injection of fast acting insulin. Physicians may also use test such as x-rays of the adrenal glands to check for calcium deposits that may indicate TB. Physicians my also use different imaging tools such as a CT scan to compare the size and shape of the patient’s pituitary gland.

The mineralocorticoid (aldosterone) is normally released by the adrenal cortex in response to decreased sodium and increased pottasium levels; the hormonally acts to promote the retention of Na and the excretion of K. It isn't working; hence the abnormal serum levels.

Cushing 's syndrome (CS) is characterized by pathologically elevated free glucocorticoid levels. Endogenous hypercortisolism is usually due to ACTH-secreting pituitary corticotropic adenomas and less often due to ectopic ACTH-secreting neuroendocrine neoplasms or ACTH-independent adrenal cortisol hypersecretion (Yaneva, 2010). Cushing 's disease occurs infrequently in an inherited setting in both of these conditions (Yaneva, 2010).

Another test that one can perform to measure the effect of an adrenal tumor is performing an ACTH test, which measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone that is produced from the pituitary gland in the brain. Thus by performing the test one can get information about its concentration in the serum. Usually if adrenal mass is influencing the corticosteroid levels the test will show a higher level of cortisol while giving a lower level of ACTH levels.

2. Due to the fact that not one single lab test is perfect, doctors will generally run a couple different kinds. The most common tests that are used to help diagnose Cushing's disease are the low-dose dexamethasone suppression test, measurement of midnight plasma cortisol or late-night salivary cortisol, and a 24-hour urinary free cortisol test. In some cases another test call the dexamethasone-corticotropin-releasing hormone test may be needed to help distinguish Cushing's disease from other causes of excess cortisol.

themselves are malfunctioning that is called primary adrenal insufficiency. Another reason that cortisol production is lacking might be because not enough ACTH is being generated by the pituitary gland. The second order effect of inadequate levels of ACTH being secreted results in cortisol not being produced. When this is the case it is called secondary adrenal insufficiency (MedlinePlus, 2011).

Primary Adrenal insufficiency (PAI) or Addison’s Disease, as it is more commonly known as, is defined as an insufficient production of glucocorticoids (cortisol). Cortisol is a regulatory hormone which is secreted and synthesised by the adrenal cortex of the adrenal glands (1).

A disorder that takes place when your body produces an insufficient amount of certain hormones that are produced by the adrenal glands is called Addison’s disease. With Addison’s disease, the adrenal glands do not produce enough cortisol and often times an insufficient amount of aldosterone as well. Doctors sometimes refer to Addison’s disease as the illness of chronic adrenal insufficiency, or also called hypocortisolism.

Suspicion may initially result from the characteristic ‘cushingoid’ appearance in addition to a history of taking steroids. Levels of cortisol can be tested from saliva or a 24-hour urine collection. Levels of ACTH in the blood are also measured, along with potassium. Additional tests may be done to locate the cause, such as a tumor. (Williams, L., & Hopper, P., 2015)

Cortisol is a glucocorticoid hormone secreted by the fasicularis layer of the adrenal cortex. One of the most common adrenal disorder is Cushing syndrome. Cushing syndrome is caused by elevated ACTH and subsequent excessive cortisol secretion. Major causes of Cushing syndrome involve ACTH-dependent, and ACTH-independent. ACTH-dependent includes ACTH-secreting pituitary adenoma, and ectopic ACTH, while ACTH-independent includes functioning adrenocortical tumor, and exogenous glucocorticoid administration.1 In ACTH-secreting pituitary adenoma, Cushing syndrome is the most common cause of noniatrogenic hypercortisolism accounts for about 60% of the cases. It is more prevalent in women than men with a diagnosed age around 20-40 years old. This

Aldosterone is the mineralocorticoid steroid which is release from the adrenal gland, situated superior to the kidney. Aldosterone play a major role for the retention of water and sodium in the nephrone (10) in the patient with congestive heart failure, cirrhosis, and nephrotic syndrome (25). The level of the Aldosterone will increase in the patient of heart failure when angiotensin I receptors is activated by Angiotensin II leading to fluid overload (10).

Mrs. J.P. is a 30-year-old African-American female who presents to the local health department for her annual women’s health exam and establishment of primary care. Mrs. J.P. requests a pregnancy test be performed due to her recent absence of menses. Mrs. J.P. states she and her spouse have been attempting pregnancy for approximately 3 months; however, with each missed cycle, pregnancy tests have been negative despite corresponding notable fatigue. Mrs. J.P. explains her current uninsured status and frustration with walk-in clinics stating recent use of multiple clinics for “simple things” without resolution. Mrs. J.P. lists her primary complaint as difficulty sleeping due to significant heart pounding in addition to her fertility concern. When encouraged to also explain recent symptoms requiring walk-in clinic assessment and completion of a health history form, she explains her ongoing diarrhea, current hand tremor, and recent onset of eye pain. She identifies all symptoms as explainable as Mrs. J.P. attributes a gluten allergy to her diarrhea, a family history of glucose abnormalities to her hand tremor, and seasonal allergies to her eye pain although medical assessment and diagnostics have not been performed. When encouraged to

ACTH-independent Cushings Syndrome typically originates from abnormalities of the adrenal gland. Adrenal adenoma and adrenal carcinoma occur when there is a benign or cancerous tumor on the adrenal gland. These tumors can cause over production of cortisol, disrupting homeostasis. Other diseases like Carney complex and McCune Albright syndrome have also been associated with abnormalities of the adrenal gland, causing overproduction of cortisol. A final form of cushings syndrome is exogenous glucocorticoid administration.