adrenal insufficiency (redirected from Hypocortisolism)

insufficiency /in·suf·fi·cien·cy/ (-sah-fish´in-se) inability to perform properly an allotted function.

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adrenal insufficiency 

1. hypoadrenalism; abnormally diminished activity of the adrenal gland.

2. adrenocortical i.

adrenocortical insufficiency  abnormally diminished secretion of corticosteroids by the adrenal cortex, as in Addison's disease.

aortic insufficiency  defective functioning of the aortic valve, with incomplete closure resulting in aortic regurgitation.

cardiac insufficiency  heart failure.

coronary insufficiency  decrease in flow of blood through the coronary blood vessels.

insufficiency of the externi  deficient power in the externi muscles of the eye, resulting in esophoria.

ileocecal insufficiency  inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.

insufficiency of the interni  deficient power in the interni muscles of the eye, resulting in exophoria.

mitral insufficiency  defective functioning of the mitral valve, with incomplete closure causing mitral regurgitation.

pulmonary insufficiency  defective functioning of the pulmonary valve, with incomplete closure causing pulmonic regurgitation.

thyroid insufficiency  hypothyroidism.

tricuspid insufficiency  defective functioning of the tricuspid valve, with incomplete closure causing tricuspid regurgitation; it is usually secondary to systolic overload.

valvular insufficiency 

1. dysfunction of a cardiac valve, with incomplete closure resulting in valvular regurgitation; named for the valve involved.

2. venous i.

velopharyngeal insufficiency  failure of velopharyngeal closure due to cleft palate, muscular dysfunction, etc., resulting in defective speech.

venous insufficiency  inadequacy of the venous valves with impairment of venous drainage, resulting in edema.

vertebrobasilar insufficiency  transient ischemia of the brain stem and cerebellum due to stenosis of the vertebral or basilar artery.

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adrenal insufficiency

Etymology: L, ad, to, ren, kidney, in, not, sufficere, to suffice

a condition in which the adrenal gland is unable to produce adequate amounts of cortical hormones. See also Addison's disease.

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adrenal

1. near the kidney.

2. of or produced by the adrenal glands.

3. an adrenal gland.

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adrenal cortex

the outer part of the adrenal gland made up of an external zona glomerulosa, a deeper zona fasciculata and a zona reticularis. It produces three main groups of hormones, the glucocorticoids which are concerned with increasing blood glucose levels, the mineralocorticoids concerned with the maintenance of electrolyte levels in the extracellular fluid, and androgens which have the same masculinizing effect as the hormone testosterone produced by the testis. Called also adrenal gland cortex. See glucocorticoid, mineralocorticoid, androgen.

adrenal cortex inhibitors

see adrenolytic.

adrenal-cortical

see adrenocortical.

adrenal cortical dysfunction

see hyperadrenocorticism, hypoadrenocorticism.

adrenal corticoids

see mineralocorticoid, glucocorticoid, corticosteroid.

adrenal function tests

see acth response test, dexamethasone suppression test, v-test.

adrenal hyperplasia-like syndrome

a congenital abnormality of adrenal steroidogenesis reported in dogs which results in hyperprogestinism and hyperandrogenism. Clinical signs include bilaterally symmetrical alopecia resembling that seen with other endocrinopathies.

adrenal insufficiency

hypofunction of the adrenal gland, particularly the cortex, leading to signs of weakness and loss of sodium, chloride and water. See also primary hypoadrenocorticism.

adrenal medulla

a glandular extension of the effector fibers of the sympathetic nervous system that releases into the bloodstream the hormones epinephrine (adrenaline) and norepinephrine (noradrenaline). When the sympathetic nervous system is stimulated the adrenal medulla responds also and its hormones are carried via the bloodstream to cause increases in cardiac output and metabolic rate, vasoconstriction and reduction of gastrointestinal peristalsis. The hormones have similar functions but epinephrine is removed from the bloodstream more slowly and has a more prolonged effect. Called also adrenal gland medulla.

Adrenal medullary hormones are not essential to life. Hypersecretion, such as occurs in some functional pheochromocytomas, causes tachycardia, edema and cardiac hypertrophy.

adrenal steroids

cortisol, corticosterone, cortisone, 11-dehydroxycortisone, desoxycorticosterone, 17-hydroxy-11-desoxycorticosterone, aldosterone, the adrenal corticoids from the adrenal cortex. Called also corticosteroids.

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insufficiency

inability to perform properly an allotted function.

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adrenal insufficiency

hypoadrenalism.

aortic insufficiency

inadequacy of the aortic valve, permitting blood to flow back into the left ventricle of the heart.

cardiac insufficiency

inability of the heart to perform its function properly; heart failure.

coronary insufficiency

decreased supply of blood to the myocardium resulting from constriction or obstruction of the coronary arteries, but not accompanied by necrosis of the myocardial cells. Called also ischemic myocardial necrosis.

hepatic insufficiency

inadequate liver function, short of hepatic failure.

ileocecal insufficiency

inability of the ileocecal valve to prevent backflow of contents from the cecum into the ileum.

pulmonary insufficiency

insufficiency of the pulmonary valve, permitting blood to flow into the right ventricle of the heart.

respiratory insufficiency

a condition in which respiratory function is inadequate to meet the body's needs when increased physical activity places extra demands on it. See also respiratory insufficiency.

thyroid insufficiency

hypothyroidism.

valvular insufficiency

failure of a cardiac valve to close perfectly, causing the blood to flow back through the orifice (valvular regurgitation); named, according to the valve affected, aortic, mitral, pulmonary or tricuspid insufficiency.

velopharyngeal insufficiency

failure of velopharyngeal closure due to cleft palate, muscular dysfunction, etc., resulting in defective swallowing with regurgitation through the nose.

venous insufficiency

inadequacy of the venous valves with impairment of venous drainage, resulting in edema.

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adrenal insufficiency

Adrenal gland insufficiency, adrenocortical insufficency, Addison's disease Endocrinology A condition characterized by a marked ↓ in adrenal function Clinical Weakness, hypotension, easy fatigability, weight loss, N&V, abdominal pain, muscle and joint pain, amenorrhea, bronzing of the skin and hyperpigmentation-especially at skin folds Management Hydrocortisone, fludrocortisone

1⁰ Adrenal insufficiency

Etiology

• Abrupt onset Adrenal hemorrhage, necrosis, thrombosis, sepsis, coagulopathy, warfarin therapy, antiphospholipid syndrome
• Slow onset Autoimmune disease, TB, adrenomyeloneuropathy, systemic fungal infection, metastatic cancer, AIDS-related-eg Kaposi sarcoma, CMV

Clinical

• Symptoms shared with 2⁰ adrenal insufficiency Tiredness, weakness, mental depression, anorexia, weight loss, vertigo, orthostatic hypotension, nausea, vomiting, diarrhea, hyponatremia, hypoglycemia, mild anemia, increase WBCs, eosinophilia
• 1⁰ adrenal insufficiency Hyperpigmentation, ↑ K⁺, vitiligo, autoimmune thyroid disease, CNS Sx if adrenomyeloneuropathy

Diagnosis

Adrenal insufficiency–exclusion of

Basal cortisol at 8-9 am–≤ 3 µg/dL–normal, 6-24 µg/dL; corticotropin stimulation test-little ↑ after stimulation–normal, plasma cortisol ≥ 20 µg/dL

• 1⁰ adrenal insufficiency Corticotropin stimulation test-no ↑ after stimulation–normal, plasma cortisol ≥ 20 µg/dL; plasma cortisol in low-normal range; plasma corticotropin always ≥ 100 pg/mL

2⁰ Adrenal insufficiency

Etiology

• Abrupt onset Postpartum pituitary necrosis, necrosis or hemorrhage into pituitary adenoma, pituitary or adrenal surgery
• Slow onset Pituitary–1º or metastatic tumor, craniopharyngioma–± accompanied by pituitary surgery or radiation, sarcoidosis, Langerhans cell histiocytosis–histiocytosis X, empty sella syndrome, hypothalamic tumors, long-term glucocorticoid therapy

Clinical

• Symptoms shared with 1⁰ adrenal insufficiency Tiredness, weakness, mental depression, anorexia, weight loss, vertigo, orthostatic hypotension, nausea, vomiting, diarrhea, hyponatremia, hypoglycemia, mild anemia, increased WBCs, eosinophilia
• 2⁰ adrenal insufficiency Pallor of skin, amenorrhea, ↓ libido, ↓ axillary and pubic hair, small testicles, 2º hyperthyroidism, defect in prepubertal growth, delayed puberty, headache, defects in vision, diabetes insipidus

Diagnosis

• Adrenal insufficiency (rule out) Basal cortisol at 8-9 am–≤ 3 µg/dL–normal, 6-24 µg/dL; corticotropin stimulation test-little ↑ after stimulation–normal, plasma cortisol ≥ 20 µg/dL
• 2⁰ adrenal insufficiency Insulin-induced hypoglycemia-little or no ↑ in plasma corticotropin and cortisol in 2º adrenal insufficiency; short metapyrone test–insufficient ↑ in plasma corticotropin and cortisol; low-dose corticotropin stimulation test-little ↑ after stimulation–normal, plasma cortisol ≥ 20 µg/dL

 NEJM 1996; 335:1206rv