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 3rd 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