Definition
adrenocortical insufficiency usually as the result of
idiopathic atrophy or destruction of both adrenal glands by
tuberculosis, an autoimmune process, or other diseases;
characterized by fatigue, decreased blood pressure, weight loss,
increased melanin pigmentation of the skin and mucous membranes,
anorexia, and nausea or vomiting; without appropriate replacement
therapy, it can progress to acute adrenocortical insufficiency.
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Radiographic Appearance
Radiology is not the primary diagnostic tool however patients
may sometimes suffer from calicifications following tuberculous
infections of the adrenal glands and these can be seen above the
renal outlines on a plain abdominal radiograph.
The most common radiological and CT appearance of adrenal
tuberculosis is calcification which can be diffuse, localized or
punctate. CT demonstrates hypodense necrotic areas with peripheral
ring enhancement on contrast administration
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Pathology
Addison's disease is a rare
endocrine or hormonal disorder that affects about 1 in 100,000
people. It occurs in all age groups and afflicts men and women
equally. The disease is characterized by weight loss, muscle
weakness, fatigue, low blood pressure, and sometimes darkening of
the skin in both exposed and nonexposed parts of the body.....Cortisol
is normally produced by the adrenal glands, located just above the
kidneys. It belongs to a class of hormones called glucocorticoids,
which affect almost every organ and tissue in the body. Scientists
think that cortisol has possibly hundreds of effects in the body.
Cortisol's most important job is to help the body respond to stress.
Among its other vital tasks, cortisol:....Because cortisol is so
vital to health, the amount of cortisol produced by the adrenals is
precisely balanced. Like many other hormones, cortisol is regulated
by the brain's hypothalamus and the pituitary gland, a bean-sized
organ at the base of the brain. First, the hypothalamus sends
releasing hormones to the pituitary gland. The pituitary responds by
secreting other hormones that regulate growth, thyroid and adrenal
function, and sex hormones such as estrogen and testosterone. One of
the pituitary's main functions is to secrete ACTH (adrenocorticotropin),
a hormone that stimulates the adrenal glands. When the adrenals
receive the pituitary's signal in the form of ACTH, they respond by
producing cortisol. Completing the cycle, cortisol then signals the
pituitary to lower secretion of ACTH.
Treatment
Often this requires the patient to enter hospital where
intravenous fluids are given to replenish the body’s salt content
which is depleted in Addison’s. Steroid are essential comprising two
types. The first is called hydrocortisone and replaces the
body’s lack of cortisol. This is usually given a tablets taken twice
or three times per day. If given twice per day then the specialist
will often ask the patient to take twice as much in the morning as
in the late afternoon so as to mimic the healthy cortisol levels
which are higher in the mornings. Also the patient will be asked to
take fludrocortisone to replace the adrenals other absent
hormone called aldosterone. Fludrocortisone is taken in the morning.
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Image 1
Adrenal TB
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UK Addison's Disease Self-Help Group website, at
http://www.adshg.org.uk
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