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| __NOTOC__ | | __NOTOC__ |
| '''For patient information, click [[Adrenal atrophy (patient information)|here]]'''
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| {{Adrenal_atrophy}} | | {{Adrenal_atrophy}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{MHP}} |
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | {{SK}} [[Adrenal atrophy]]; [[Adrenal insufficiency]]; [[Adrenal crisis]] |
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| ==[[Adrenal atrophy historical perspective|Historical Perspective]]== | | ==[[Adrenal atrophy historical perspective|Historical Perspective]]== |
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| There is limited information about the historical perspective of adrenal atrophy.
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| ===[[Famous Cases]]===
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| The following are a few famous cases of adrenal atrophy:
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| *President John F. Kennedy was diagnosed with Addison’s disease after his election in 1960, due to an autoimmune disease, attacking the adrenal tissue.
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| *The King Henry VIII was known as a domineering, philanderer king, who became bloated and significantly obese after 35 years of being in power. Historian Robert Hutchinson has theorized that he has had Cushing’s Syndrome.
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| ==[[Adrenal atrophy classification|Classification]]== | | ==[[Adrenal atrophy classification|Classification]]== |
| There is no established system for the classification of adrenal atrophy.
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| However, adrenal insufficiency may be classified into three subtypes based on its cause:
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| *Primary adrenal insufficiency due to impairment of the adrenal glands. Causes:
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| **Autoimmune disease in 80% of the cases.
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| **Congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.
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| **Infections (TB, CMV, histoplasmosis, paracoccidioidomycosis).
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| **Vascular (hemorrhage from sepsis, adrenal vein thrombosis, HIT).
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| **Deposition disease (hemochromatosis, amyloidosis, sarcoidosis).
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| **Drugs (azole anti-fungals, etomidate (even one dose), rifampin, anticonvulsants).
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| *Secondary adrenal insufficiency is caused by impairment of the pituitary gland. Causes:
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| **Pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced).
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| **Sheehan's syndrome.
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| *Tertiary adrenal insufficiency is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes:
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| **Sudden withdrawal from long-term exogenous steroid use (which is the most common cause overall).
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| **Brain tumor.
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| Adrenal cortical atrophy may be focal or diffuse. Compared with the normal adrenal cortex, the atrophic cortex is characterized by reduced thickness of the one or more of the cortical layers due to a decrease in cell size or a loss of cells. The zonae fasciculata and reticularis are more often affected than the zona glomerulosa. There is variably decreased overall size of the gland, often with distortion of the gland outline. The glandular capsule may be thickened due to fibrosis.<ref name="pmid6285687">{{cite journal |vauthors=Conran RM, Nickerson PA |title=Atrophy of the zona fasciculata in the adrenal cortex of thyroparathyroidectomized rats: a quantitative study |journal=Am J Anat |volume=164 |issue=2 |pages=133–43 |date=June 1982 |pmid=6285687 |doi=10.1002/aja.1001640204 |url=}}</ref><ref name="pmid20719838">{{cite journal |vauthors=Grossman AB |title=Clinical Review#: The diagnosis and management of central hypoadrenalism |journal=J Clin Endocrinol Metab |volume=95 |issue=11 |pages=4855–63 |date=November 2010 |pmid=20719838 |doi=10.1210/jc.2010-0982 |url=}}</ref>
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| ==[[Adrenal atrophy pathophysiology|Pathophysiology]]== | | ==[[Adrenal atrophy pathophysiology|Pathophysiology]]== |
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| ==[[Adrenal atrophy causes|Causes]]== | | ==[[Adrenal atrophy causes|Causes]]== |
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| ==[[Adrenal atrophy differential diagnosis|Differentiating Adrenal atrophy from other Diseases]]== | | ==[[Adrenal atrophy differential diagnosis|Differentiating Adrenal atrophy from other Diseases]]== |
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| Adrenal atrophy must be differentiated from other diseases that cause salt wasting and nausea or vomiting and yield to the adrenal hormone imbalance. Among the main diseases are:
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| *Adrenal Crisis
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| *Adrenal Hemorrhage
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| *C-17 Hydroxylase Deficiency
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| *Eosinophilia
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| *Histoplasmosis
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| *Hyperkalemia
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| *Sarcoidosis
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| *Tuberculosis (TB)
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| In addition, hyponatremia and hyperkalemia may result from chronic renal insufficiency due to inadequate production of renin and consequent aldosterone deficiency.<ref name="pmid26981183">{{cite journal |vauthors=Sousa AG, Cabral JV, El-Feghaly WB, de Sousa LS, Nunes AB |title=Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology assumptions, clinical aspects and implications for management |journal=World J Diabetes |volume=7 |issue=5 |pages=101–11 |date=March 2016 |pmid=26981183 |pmc=4781902 |doi=10.4239/wjd.v7.i5.101 |url=}}</ref><ref name="pmid19500759">{{cite journal |vauthors=Husebye E, Løvås K |title=Pathogenesis of primary adrenal insufficiency |journal=Best Pract Res Clin Endocrinol Metab |volume=23 |issue=2 |pages=147–57 |date=April 2009 |pmid=19500759 |doi=10.1016/j.beem.2008.09.004 |url=}}</ref>
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| ==[[Adrenal atrophy epidemiology and demographics|Epidemiology and Demographics]]== | | ==[[Adrenal atrophy epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Treatment== | | ==Treatment== |
| [[Adrenal atrophy medical therapy|Medical Therapy]] | [[Adrenal atrophy primary prevention|Primary Prevention]] | [[Adrenal atrophy secondary prevention|Secondary Prevention]] | [[Adrenal atrophy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Adrenal atrophy future or investigational therapies|Future or Investigational Therapies]] | | [[Adrenal atrophy medical therapy|Medical Therapy]] | [[Adrenal atrophy interventions|Interventions]] | [[Adrenal atrophy surgery|Surgery]] | [[Adrenal atrophy primary prevention|Primary Prevention]] | [[Adrenal atrophy secondary prevention|Secondary Prevention]] | [[Adrenal atrophy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Adrenal atrophy future or investigational therapies|Future or Investigational Therapies]] |
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| ==Case Studies== | | ==Case Studies== |
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| [[Adrenal atrophy case study one|Case #1]] | | [[Adrenal atrophy case study one|Case #1]] |
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| {{Endocrine pathology}}
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| [[Category:Growth disorders]]
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| [[Category:Neurological disorders]]
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| [[Category:Endocrinology]]
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