Adrenal Anatomy Outer Cortex aldosterone secretion Inner Cortex

Adrenal Anatomy • Outer Cortex – aldosterone secretion • Inner Cortex – cortisol and adrenal androgens • Medulla - epinephrine

Gross Anatomy • • • Pyramidal structure 2 -3 cm wide 4 -6 cm long 1 cm thick Usual wt 4 gm (up to 22 gm with chronic illness and stress) • 3% of adults – macro-nodules • 65% of adults – microscopic nodules

Ectopic Adrenal Tissue • • Cortical Tissue Retroperitoneal celiac plexus Hilum of spleen Ovaries Scrotum Liver Wall of gallbladder Cranium

Causes of Primary Adrenal Insufficiency

Autoimmune Adrenalitis • Humoral and cell-mediated • Antibodies to 21 -hydroxylase or other steroidogenic enzymes and all 3 zones of adrenal cortex • Polyglandular – 70% females • Isolated autoimmune – 71% males in first 2 decades, equal in 3 rd decade and 81% female subsequently

Adrenal insufficiency • First indication – increased plasma renin with nl or low serum aldo – zona glomerulosa • Next – decreasing cortisol and elevated ACTH

Adrenal Insufficiency • ½ have other autoimmune endocrine disorders • Contrary is not as common • <1% of Type 1 diabetics have adrenal insufficiency

PGA Type 2 • • Much more common ½ of cases are familial Several modes of inheritance 2 times more frequent in women

Treatment of Adrenal Insufficiency • Acute Treatment of Adrenal Crisis • Chronic Therapy • Treatment During Concurrent Illness