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Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones. The adrenal glands—also referred to as the adrenal cortex—normally secrete glucocorticoids (primarily cortisol), mineralocorticoids (primarily aldosterone), and androgens.
Adrenal crisis, also known as Addisonian crisis or acute adrenal insufficiency, is a life-threatening complication of adrenal insufficiency. Hypotension and hypovolemic shock are the main symptoms of an adrenal crisis. Other symptoms include weakness, anorexia, nausea, vomiting, fever, fatigue, abnormal electrolytes, confusion, and coma.
Schematic of the HPA axis (CRH, corticotropin-releasing hormone; ACTH, adrenocorticotropic hormone) Hypothalamus, pituitary gland, and adrenal cortex The hypothalamic–pituitary–adrenal axis (HPA axis or HTPA axis) is a complex set of direct influences and feedback interactions among three components: the hypothalamus (a part of the brain located below the thalamus), the pituitary gland (a ...
Adrenal glands, anterior (left) and posterior (right) surface. The adrenal glands are located on both sides of the body in the retroperitoneum, above and slightly medial to the kidneys. In humans, the right adrenal gland is pyramidal in shape, whereas the left is semilunar or crescent shaped and somewhat larger. [8]
With prolonged suppression, the adrenal glands atrophy (physically shrink), and can take months to recover full function after discontinuation of the exogenous glucocorticoid. During this recovery time, the patient is vulnerable to adrenal insufficiency during times of stress, such as illness. While suppressive dose and time for adrenal ...
Such adrenal suppression is a way for a virus to evade immune detection and elimination. [ 22 ] [ 23 ] [ 24 ] This viral strategy can have severe consequences for the host (human that is infected by the virus), as cortisol is essential for regulating various physiological processes, such as metabolism, blood pressure, inflammation, and immune ...
Two dexamethasone suppression tests (DSTs) are generally used, the overnight test and the 48 hour test. [8] For both tests, a plasma cortisol level above 50 nmol/L is indicative of Cushing's disease. [8] However, 3–8% of patients with Cushing's disease will test negative due to a retention of dexamethasone suppression abilities. [8]
Rapid onset of symptoms indicates acute adrenal failure, which is a clinical emergency. [5] An adrenal crisis can be triggered by stress, such as from an injury, surgery, or infection. [1] Addison's disease arises when the adrenal gland does not produce sufficient amounts of the steroid hormones cortisol and (sometimes) aldosterone. [1]