- Adrenal insufficiency refers to the inability of the adrenal gland to produce sufficient amounts of glucocorticoid and, occasionally, mineralocorticoids to meet the body's needs.
- Total adrenal insufficiency can be fatal. In Addison's syndrome, the destruction of the adrenal gland is incomplete.
Effects:
- Cortisol deficiency leads to decreased fasting blood glucose levels due to reduced gluconeogenesis. Some patients may also exhibit postprandial hypoglycemia because of increased insulin sensitivity. This deficiency depresses many metabolic functions due to decreased protein and fat mobilization, resulting in anorexia, weight loss, fatigue, and muscle weakness. It also causes pigmentation of mucous membranes and decreased resistance to various types of stress.
- Aldosterone deficiency results in reduced renal tubular Na reabsorption, leading to hyponatremia, polyuria, K retention causing hyperkalemia, and H retention leading to mild metabolic acidosis. This condition can cause cardiac arrhythmias, weakness of cardiac contractility, and shock if untreated.
Types:
1. Primary adrenal insufficiency is due to the loss of gland function resulting in a deficiency of aldosterone and cortisol production. This leads to hypotension, hyperkalemia, metabolic acidosis, and skin and mucosal hyperpigmentation. It may be either acute or chronic.
A. Acute:
- It has a sudden onset, usually due to massive hemorrhage.
- It may present with shock in an acute adrenal crisis.
- Waterhouse-Friderichsen syndrome: This is acute primary adrenal insufficiency due to adrenal hemorrhage, usually associated with septicemia (often caused by Neisseria meningitidis), DIC, and endotoxic shock.