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==Classification== | ==Classification== | ||
There is no established system for the classification of adrenal atrophy. | |||
However, adrenal insufficiency may be classified into three subtypes based on its cause: | |||
*Primary adrenal insufficiency due to impairment of the adrenal glands. Causes: | |||
**Autoimmune disease in 80% of the cases. | |||
**Congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland. | |||
**Infections (TB, CMV, histoplasmosis, paracoccidioidomycosis). | |||
**Vascular (hemorrhage from sepsis, adrenal vein thrombosis, HIT). | |||
**Deposition disease (hemochromatosis, amyloidosis, sarcoidosis). | |||
**Drugs (azole anti-fungals, etomidate (even one dose), rifampin, anticonvulsants). | |||
*Secondary adrenal insufficiency is caused by impairment of the pituitary gland. Causes: | |||
**Pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced). | |||
**Sheehan's syndrome. | |||
*Tertiary adrenal insufficiency is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes: | |||
**Sudden withdrawal from long-term exogenous steroid use (which is the most common cause overall). | |||
**Brain tumor. | |||
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> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Classification
There is no established system for the classification of adrenal atrophy.
However, adrenal insufficiency may be classified into three subtypes based on its cause:
- Primary adrenal insufficiency due to impairment of the adrenal glands. Causes:
- Autoimmune disease in 80% of the cases.
- Congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.
- Infections (TB, CMV, histoplasmosis, paracoccidioidomycosis).
- Vascular (hemorrhage from sepsis, adrenal vein thrombosis, HIT).
- Deposition disease (hemochromatosis, amyloidosis, sarcoidosis).
- Drugs (azole anti-fungals, etomidate (even one dose), rifampin, anticonvulsants).
- Secondary adrenal insufficiency is caused by impairment of the pituitary gland. Causes:
- Pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced).
- Sheehan's syndrome.
- Tertiary adrenal insufficiency is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes:
- Sudden withdrawal from long-term exogenous steroid use (which is the most common cause overall).
- Brain tumor.
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.[1][2]
References
- ↑ Conran RM, Nickerson PA (June 1982). "Atrophy of the zona fasciculata in the adrenal cortex of thyroparathyroidectomized rats: a quantitative study". Am J Anat. 164 (2): 133–43. doi:10.1002/aja.1001640204. PMID 6285687.
- ↑ Grossman AB (November 2010). "Clinical Review#: The diagnosis and management of central hypoadrenalism". J Clin Endocrinol Metab. 95 (11): 4855–63. doi:10.1210/jc.2010-0982. PMID 20719838.