Acute Adrenal Insufficiency Adrenal Crisis

predisposing factors for glucocorticosteroid

.Lack of glucocorticosteriod hormones - major predisposing factor in acute adrenal insufficiency This insufficiency develops through 6 mechanisms

Adrenocortical suppression should be suspected if a patient has received glucocorticosteroid therapy through two of the following methods.

1. In a dose of 20 mg or more of cortisone or its equivalent 2.Via the oral or parenteral route for a continuous period of 2 weeks or longer 3.Within 2 years of dental therapy

Hypersecretion of cortisol affects

1. increase fat deposition 2. face & back " buffalo hump" 3. elevates BP 4. alters blood cell distrubtion 5. usually DOES NOT result in acute life threatening situation

how long does it take to achieve full recovery of adrenal function following prolonged exogenous steroid therapy in patients with normal function

9 months and others 2 yrs

Secondary adrenal insufficiency is a greater potential threat than?

Addison's Diseasein the development of acute adrenal crisis

Mechanism 6

After both adrenal glands are injured through trauma, hemorrhage, infection, thrombosis or tumor

Mechanism 3

After stress, either physiologic or psychological Physiologic stress - traumatic injuries, surgery, Psychological stress

Mechanism 5

After the sudden destruction of the pituitary gland.

Clinical Indications for Glucocorticosteroid Use

Allergic diseases Cardiovascular diseases Eye Diseases Gastrointestinal Diseases Genitourinary Diseases Hematopoietic disorders Infections/inflammations Arthritis Pulmonary Diseases Skin Diseases

prevention

Health History Glucocorticosteroid? Rule of twos Medical conditions Rheumatic fever Asthma, hay fever Allergies Arthritis Addison's Disease

Mechanism 4

Removal of functioning adrenal tumor results in suppressing the other adrenal gland.

Mechanism 1

Sudden withdrawal of steroid hormone in patient with Addison's Disease Patients with Addison's disease require lifelong administration of glucocorticosteroids

Mechanism 2

Sudden withdrawal of steroid hormones in patient with normal adrenal cortices but with temporary insufficiency resulting from corticosteroid suppression through prolonged exogenous administration of glucocorticosteroid (secondary insufficiency)

(secondary)Administration of exogenous glucocorticosteroids to a patient with functional adrenal cortices may produce

adrenocortical hypofunction.

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol

Most important product of adrenal cortex

cortisol

Exogenous glucocorticosteroid administration produces

disuse atrophy of the adrenal cortex, (decreasing the ability of the adrenal cortex to increase corticosteroid levels response of stress)

adrenal gland

endocrine gland combination of 2 glands ( cortex and medulla fused together yet distinct)

cortisol

glucocorticoid helps body adapt to stress ** vital for survival

Mechanism 4,5,6 occur more often in what kind of patients

hospital patients

Addison's disease

primary adrenal insufficiency - No clinical symptoms until 90% cortex destroyed

adrenal cortex

secretes more than 30 steroid hormones

Most common factor in majority of cases of acute adrenal insufficiency

stress

Acute adrenal insufficiency can develop during what?

stressful situations

most common cause of adrenal insufficiency

use of glucocorticosteroids