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

2. 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

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

5. Causes of Primary Adrenal Insufficiency

7. 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

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

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

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

18. Treatment of Adrenal Insufficiency Acute Treatment of Adrenal Crisis Chronic Therapy Treatment During Concurrent Illness