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);

•  acute hemorrhagic destruction of both adrenal glands:

 —   anticoagulant therapy or a coagulation disorder;

 —   septicemia with Pseudomonas or meningococcemia (in children - the Waterhouse-Friderichsen's syndrome).