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