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

• 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;

• intensification of chronic adrenal insufficiency (e.g. due to sepsis or surgical stress);