1. Conditions Affecting Adrenal
Cortex
Adrenocortical Hyperfunction
Cushing’s syndrome
Increased glucocorticoid levels
Hyperaldosterone
Excessive water retention  Ht
Adrenocortical Insufficiency
Acute Adrenocortical Insufficiency
Chronic Adrenocortical Insuffeciency (Addison’s)

2. DEFINITION
Addison's disease (Adrenal insufficiency) or Adrenocortical Insufficiency.
1st described in 1855 by Dr. Thomas Addison
-An Endocrine or hormonal disorder that occurs when the adrenal glands do
not produce enough of certain hormones
Can be fatal if left untreated.It includes the underproduction of hormones
that the adrenal cortex produces. the gland affected is the adrenal cortex.
Addison’s disease develops when the level of adrenal cortex
hormone is low due to hyposecretion (lack of secretion).
•Addison's disease is hypo function of the adrenal cortex.
•There is a decrease in adrenal steroids which are: glucocorticoids, mineral corticoids, and
androgen.
•The adrenal cortex function is inadequate to meet the
patients need for cortical steroids.
•Addison's disease occurs when 90% of the adrenal
cortex has been destroyed

3. Hormones Involved
Adrenocorticotropic (ACTH)
Glucocorticoids (cortisol)
Mineralocorticoids (aldosterone)
 How Are the Hormones Affected?
When Addison’s disease goes into affect, the Anterior
pituitary produces excessive but ineffective amounts of
Adrenocorticotropic (ACTH) to the adrenal cortex thus
hindering its ability to produce and release hormones
(Glucocorticoids and Mineral corticoids).
Since there is no ACTH to stimulate the adrenal cortex to
release its hormones, the adrenal cortex can not release
hormones to regulate processes in the body.

4. Function of cortisol
 Cortisol is normally produced by the adrenal gland
It belongs to the class of hormone called, glucocorticoids.
cortisol perform the following vital tasks:
 Maintain BP and Cardiovascular function
 Helps slow the immune system’s inflammatory
responses
 Helps balance the effects of insulin in breaking sugar
for energy; and
 Helps to regulate the metabolism of
proteins,carbohydrates and fats.

5. Functions of Aldosterone
• Aldosterone is a mineralocorticoid secreted
by the adrenal cortex.
• Aldosterone regulates sodium and potassium
balance by causing the kidney to
- excrete potassium
- reabsorb sodium.
• Aldosterone is secreted in response to
- low blood volume
- low blood pressure
- low blood [sodium]
- high blood [potassium

6. Aldosterone
Decreased Aldosterone causes:
• Hyponatremia
• Polyuria with loss of salt & H2O eventually may cause
CV collapse & circulatory shock.
• Dehydration with polydipsia
• Orthostatic (postural) hypotension
• Decreased cardiac output
• Hyperkalemia
• Salt craving

7. Decreased Glucocorticoids
Decreased Glucocorticoids cause:
•Hypoglycemia
•Poor tolerance to stress (infections, trauma, surgery)
causing an “adrenal crisis” with hypoglycemia,
hypotension & shock, lethargy, weakness.
Addison patients need a medical alert bracelet
•Lethargy
•Weakness
•GI symptoms (anorexia, nausea, vomiting,weight loss)
•fever

8. Excess of ACTH
Excess ACTH in Addison patients causes
hyperpigmentation of the skin, gums, mouth
from formation of a derivative of ACTH (Melanocyte
Stimulating Hormone - MSH) that targets the skin.
• Signs of hyperpigmentation distinguishes Addison
Disease (Primary Adrenal Insufficiency) from
Secondary Adrenal Insufficiency due to lack of ACTH.

9. Addison’s disease
causes
PRIMARY
 destruction of adrenal cortex
- autoimmune disorders
- tuberculosis
- chronic infection
SECONDARY
 Lack of ACTH
- drugs
- tumors and
infections of
pituitary gland
In short the cause is the following.
•Autoimmune or idiopathic atrophy of the adrenal
glands is responsible for 80% to 90% of cases.
•Surgical removal of both adrenal glands
•Infection of the adrenal glands
•Tuberculosis and histoplasmosis are the most common infections that destroy
adrenal gland tissue.
•Inadequate secretion of ACTH from the pituitary
gland. (Decreased stimulation of the adrenal cortex)
•Therapeutic use of corticosteroids.

10. SIGNS AND SYMPTOMS
 Manifestations of Addison Disease result from
• Lack of Aldosterone
• Lack of Glucocorticoids
• Elevated ACTH.
• Early signs:
 Tiredness, Weakness, Loss of appetite, Weight loss
 Dizziness when standing, Muscle aches, Nasuea, vomiting,
Diarrhea
 Patches of darkened, skin or unexplained tanning, Depression
•Late signs:
 Sharp pain in the lower back,abdomen, or legs, Loss of too much
fluid From body.(Dehydration)
 Hypotension, Loss of consciousness

11. HOW IS IT DIAGNOSED?
 Early stages difficult to diagnose.
Check Cortisol levels
•ACTH Stimulation Test
•CRH Stimulation Test
•Other tests
X-RAY

12. Physical findings
Hyperpigmentation
Hypotension
Orthostatic changes
Weak pulses
Shock
Loss of axillary/pubic hair
(women)

13. Laboratory findings
Hyponatremia
Hyperkalemia
Hypoglycemia
Narrow cardiac silhouette on CXR
Low voltage EKG

14. Treatment
Treatment

15. Addison Disease - Treatment
• Addison Disease is a chronic disorder requiring
lifelong hormone replacement therapy with higher doses
given in times of stress.
• Hormones used are Oral hydrocortisone (glucocorticoid
with some salt retention effects) & a mineralocorticoid
(flurocortisone).
• Female patients may also be given an adrenal androgen to
promote muscle mass, hemopoiesis & support sexual libido
(all normal functions of adrenal androgens in females).
• Addison patients must be monitored carefully for
signs of infection & hypoglycemia & need scheduled
meals.

16. treatment
REPLACEMENT THERAPY
 CORTISOL_HYDROCORTISONE
 ALDOSTERONE_FLUDROCORTISONE

17. TREATMENT
continued..
• Hormone replacement therapy
•Depending on which hormone is low (if not all
three)
Glucocorticoid twice a day
Mineralcorticoid once a day
Aldosterone therapy involves increased sodium

18. ADDISONIAN CRISIS
Symptoms include sudden penetrating pain in:
lower back
abdomen or legs
severe vomiting
diarrhea
followed by dehydration
low blood pressure
loss of consciousness