Adrenal Insufficiency
Adrenal Insufficiency Definition
There are two classifications for adrenal insufficiency and they are: primary and secondary. The primary adrenal insufficiency happens when the adrenal gland dysfunctions. The secondary adrenal insufficiency which is also named central adrenal insufficiency happens there is a lack of CRH secretion or the corticotrophin-releasing hormone from the hypothalamus; or it could be the lack of ACTH secretion which is the corticotropic hormone from the pituitary. The second type leads to adrenal cortex hypofunction. Further classifications include acquired and congenital.
Adrenal Insufficiency Frequency
In the United States alone, primary adrenal insufficiency is not a common illness when compared with iatrogenic central adrenal insufficiency. Adrenal insufficiency secondary to inborn adrenal hyperplasia manifests in about 1 of every 16,000 births. In the UK, adrenal insufficiency is prevalent at 110 cases in every 1,000,000 individuals (all age brackets are included). More than 90% of all the reported cases are linked with autoimmune disease. An Italian observation has reported about the same number of cases in their country (estimated at 117 patients in every 1,000,000 individuals). Globally, tuberculosis is the most common sign of adrenal insufficiency. The estimated incidents of TB-caused adrenal insufficiency are at 5 or 6 for every 1,000,000 persons annually.
Adrenal Insufficiency Symptoms and Signs
Those who suffer from severe adrenal insufficiency usually manifest acute dehydration; hypoglycemia; hypotension; or the mental status of the patient being altered. These ordinarily occur in a patient that is already acutely ill (with sepsis or dispersed intravascular coagulation or a patient following a traumatic delivery. Patients with the severe type of adrenal insufficiency could have increased pigmentation of the skin especially on the genital region or the areola. They could also have some moles or scars. The most affected scars are the most recent ones. The areas of the body that are not regularly exposed to the sun (like the axillae, areola and palmar creases) are commonly hyperpigmented. Pigmentary lines could also occur on the gums. There are also cases of adrenal insufficiency where the manifestations are: weight loss; hypotension; orthostatic hypotension; loss of axillary or pubic hairs; and some patients do not become victims of alopecia because of the adrenal androgens that are being produced. OMIM 278000 or the Wolman disease is an autosomal recessive disease which is caused by a lac of lysosomal acid lipase. Wolman disease is generally coupled with adrenal calcification or heptosplenomegaly. These are often plainly seen on CT scans or radiographs of the adrenal glands.