Clinical Case Database / Category: Case Based Discussion
Adrenal physiology & primary adrenal insufficiency
Dr Muhammad Ali Karamat, Dr Mohamed Salih Ahmed
Foundation Years Journal, volume 8, issue 5, p.46 (123Doc Education, London, May 2014)
The adrenal gland is composed of adrenal cortex (which is divided into 3 zones in the adult gland) and the adrenal medulla. The cortex produces aldosterone, sex hormones and cortisol, which are all synthesized from cholesterol. Adrenal medulla produces the catecholamines. Cortisol is an endogenous steroid, which is essential for life. Aldosterone promotes sodium retention and potassium elimination by the kidney. Catecholamines stimulate the â€œfight or fightâ€ reaction.
Adrenal insufficiency is a life-threatening disorder, which is characterized by deficient production or action of glucocorticoids and/or mineralocorticoids and adrenal androgens. Adrenal insufficiency may result from disorders affecting the adrenal cortex (primary), or the anterior lobe of pituitary gland/hypothalamus (secondary).The clinical diagnosis of adrenal insufficiency can be confirmed by demonstrating inappropriately low cortisol secretion.
Treatment of adrenal insufficiency should be initiated as soon as the diagnosis is confirmed, or even sooner if the patient presents in an adrenal crisis. Education to the patient and caregivers is essential part of the management. Acute adrenal crisis is an emergency, which requires prompt intervention, can manifest as a hypovolemic shock. Management is by supportive measures and intravenous glucocorticoid replacement.
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Dr Muhammad Ali Karamat
Consultant Physician and Honorary Senior Lecturer,
Diabetes and Endocrinology, Diabetes Center,
Bordesley Green East, Birmingham, B9 5SS.
Dr Mohamed Salih Ahmed
SPR Diabetes and Endocrinology,
Birmingham Heartlands Hospital,
Diabetes and endocrinology Centre, Bordesley Green East, Birmingham, B9 5SS.
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