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29. TYPICAL FORMS OF PATHOLOGY OF THE ADRENAL GLANDS AND SEX GLANDS

PATHOPHYSIOLOGY OF THE ADRENAL GLANDS

There are two main forms of the adrenal dysfunction: hyperfunction and hypofunction (fig. 38).

Causes of the adrenal cortex hypofunction.

 Primary - inability of the adrenals to elaborate sufficient quantities of hormones.

 Secondary - low production of adrenal hormones due to the inadequate ACTH formation or release.

Primary total chronic adrenocortical deficiency - Addison's disease

Etiology.

 Idiopathic atrophy (autoimmune).

 Chronic granulomatous diseases:

- tuberculosis, histoplasmosis, coccidioidomycosis, cryptococcosis.

 Bilateral hemorrhage.

 Tumor metastases.

 Amyloidosis.

 Adrenomyeloneuropathy.

 Familial adrenal insufficiency.

 Sarcoidosis.

Clinical signs and symptoms of the chronic total adrenocortical insufficiency (Addison's disease):

 insidious onset of fatigability;

 weakness, anorexia;

Fig. 38. Typical forms of pathology of adrenal glands

 nausea and vomiting;

 diarrhea, abdominal pains;

 weight loss;

 cutaneous and mucosal pigmentation;

 hypotension;

 occasionally, hypoglycemia;

 personality changes: excessive irritability, restlessness.

Laboratory findings in Addison's disease:

 serum levels of [Na], [Cl], [HCO3] are reduced;

 serum level of [K] is elevated;

 plasma ACTH and associated peptides (beta-lipotropin) are elevated;

 basal levels of cortisol and aldosterone are subnormal and fail to increase following ACTH administration.

Secondary total adrenocortical insufficiency

Etiology of the acute form:

 rapid withdrawal of steroids from patients with adrenal atrophy owing to chronic steroid administration;

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