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Adrenal Destruction

Destructive Procedure on Adrenal Gland


Presentation

  • Covers clinical biochemistry from the point of view of the clinician using the diagnostic service Presents topics in easily accessible two-page spreads Includes mini case histories, key point boxes, flowcharts, and summary points Well illustrated with[books.google.com]
  • The purpose of the present study was to perfect histological techniques for fixation, sectioning and staining of the adrenal glands, and to evaluate the success of the cryo-destruction.[cornerstone.lib.mnsu.edu]
  • Possible presentations The most common is the child with known adrenal insufficiency who has an intercurrent illness.[kidshealthwa.com]
Physician
  • Authoritative and insightful, Adrenal Disorders provides physicians and scientists with a comprehensive, state-of-the-art practical guide to the devastating diseases of the adrenals that are so often difficult to diagnose and treat.[books.google.com]
  • By using our Physician Directory , you can search for a New Jersey physician by specialty, facility, town, and zip code right now. For more information on any physician, call 1-800-DOCTORS or 1-800-560-9990.[jerseyshoreuniversitymedicalcenter.com]
  • Proper maintenance treatment requires regular visits to a physician for examinations, laboratory tests, and discussions about symptoms.[nadf.us]
  • […] high dose hydrocortisone (100mg IV Q6 hrly) mineralocorticoid replacement (fludrocortisone PO 0.1mg Q6 hrly) – don’t often use this acutely as with 50mg of hydrocortisone you get a mineralocorticoid effect About Dr Chris Nickson An oslerphile emergency physician[lifeinthefastlane.com]
  • The condition is named after the British physician Thomas Addison (1793-1860). CONTINUE SCROLLING OR CLICK HERE FOR RELATED ARTICLE Reviewed on 12/27/2018[medicinenet.com]
Hypothermia
  • Haemochromatosis Congential causes Adrenal dysgenesis Adrenoleucodystrophy Impaired steroidogenesis Empty sella syndrome Autoimmune destruction Addisons's disease Traumatic destruction Trauma is a major cause of adrenal insufficiency Environmental factors Hypothermia[derangedphysiology.com]
  • As cortisol levels remain low, patients may develop severe hypotension, vascular collapse, acute renal failure, and hypothermia.[pharmacytimes.com]
Surgical Procedure
  • ., illness, invasive surgical procedures), stress-dose glucocorticoids are required because destruction of the adrenal glands prevents an adequate physiologic response.[aafp.org]
  • In the face of stress, such as a surgical procedure or serious trauma, hydrocortisone secretion can rise more than 10-fold.[what-when-how.com]
Disability
  • Geme, Nina F Schor Publisher: Elsevier Endorsed by: Director, Emergency Department Date: Jan 2017 This document can be made available in alternative formats on request for a person with a disability.[kidshealthwa.com]
Sore Throat
  • throat, or infection Report tiredness, stomach pain, weakness, high/low blood sugar Do not d/c abruptly if taking chronically.[quizlet.com]
Vomiting
  • If vomiting or diarrhoea treat as below.[kidshealthwa.com]
  • In major stress (temperatures above 38 degrees C and/or vomiting), the hydrocortisone dose should be increase to three to four times the normal replacement.[pedclerk.bsd.uchicago.edu]
  • Immediate medical attention is needed when severe infections, vomiting, or diarrhea occur, as these conditions can precipitate an Addisonian crisis. A patient who is vomiting may require injections of hydrocortisone instead.[checkorphan.org]
  • DI) Secondary hypothyroidism Decreased libido and potency, amenorrhea Visual symptoms, headache Primary, Secondary & Tertiary Adrenal Insufficiency (AI): Fatigue Fever Weakness Salt craving Orthostatic hypotension, dizziness, hypovolemic shock Nausea/vomiting[specialty.mims.com]
  • EMERGENCY If you have been diagnosed with Addison’s disease and experience symptoms of severe lethargy, nausea, vomiting, dizziness, or dehydration, get immediate medical assistance. These may be indications of adrenal crisis.[healthcommunities.com]
Nausea
  • […] insipidus (DI) Secondary hypothyroidism Decreased libido and potency, amenorrhea Visual symptoms, headache Primary, Secondary & Tertiary Adrenal Insufficiency (AI): Fatigue Fever Weakness Salt craving Orthostatic hypotension, dizziness, hypovolemic shock Nausea[specialty.mims.com]
  • EMERGENCY If you have been diagnosed with Addison’s disease and experience symptoms of severe lethargy, nausea, vomiting, dizziness, or dehydration, get immediate medical assistance. These may be indications of adrenal crisis.[healthcommunities.com]
  • Common non-specific symptoms include fatigue and weakness as well as nausea, vomiting, anorexia, and weight loss. Deficiencies in cortisol synthesis typically lead to hypoglycemia.[pathwaymedicine.org]
  • Metabolic decompensation Fatigue, anorexia, nausea, hyperpigmentation Increased ACTH and decreased 8 a.m. cortisol levels; high clinical suspicion needed for diagnosis 5.[aafp.org]
  • […] weakness Fatigue Dizziness Rapid pulse Dark skin (first noted on hands and face) Black freckles Bluish-black discoloration around the nipples, mouth, rectum, scrotum, or vagina Weight loss Dehydration Loss of appetite Intense salt craving Muscle aches Nausea[stanfordchildrens.org]
Hypotension
  • , refractory shock, poor response to inotropes/pressors fever confusion CHRONIC ADRENAL INSUFFICIENCY GENERAL: weight loss, arthralgia, myalgia CNS: fatigue, anorexia, mood change CVS: postural hypotension, syncope, salt craving SKIN: pigmentation, vitiligo[lifeinthefastlane.com]
  • Tertiary Adrenal Insufficiency (AI): Manifestations usually begin in the first 48 hours after steroid medication has been discontinued Similar to primary AI except that hyperpigmentation and dehydration are absent; Gastrointestinal (GI) symptoms and hypotension[specialty.mims.com]
  • Hypotension. Postural hypotension. Other situations which should provoke consideration of Addison's disease include: People with hypothyroidism in whom symptoms get worse when thyroxine treatment is commenced.[patient.info]
  • Measurement of plasma renin levels should be considered first in patients with continued salt craving or hypotension.[themedicalbiochemistrypage.org]
  • Other symptoms include vertigo, hypotension, depression, salt craving, and vitiligo (depigmented patches of skin).[pharmacytimes.com]
Hypertension
  • The spread on hypertension will be revised and updated to reflect the fact that biochemistry is used as much or more in guiding treatment as it is in screening for secondary hypertension.[books.google.com]
  • Due to its effects on blood volume, aldosterone has been implicated in the development of hypertension, or high blood pressure.[cornerstone.lib.mnsu.edu]
  • The main clinical manifestation of pheochromocytomas is hypertension. The hypertension can be sustained or episodic; the two forms occur with equal frequency.[what-when-how.com]
  • Ultimately, aldosterone release can lead to hypertension and edema.[pharmacytimes.com]
Orthostatic Hypotension
  • Although there are classic clinical signs (eg, fatigue, orthostatic hypotension, hyperpigmentation, hyponatremia, hyperkalemia, and hypoglycemia) of adrenal insufficiency, its early clinical presentation is most commonly vague and undefined, requiring[ncbi.nlm.nih.gov]
  • hypotension, dizziness, hypovolemic shock Nausea/vomiting, abdominal pain, tenderness and guarding Diarrhea Anorexia, weight loss Confusion, somnolence In severe cases, delirium or coma Signs & Symptoms of Acute Adrenal Insufficiency (AI) Acute adrenal[specialty.mims.com]
  • On physical examination, the following clinical signs may be noticed Low blood pressure with or without orthostatic hypotension (blood pressure that decreases with standing) Darkening (hyperpigmentation) of the skin, including areas not exposed to the[checkorphan.org]
  • Additional signs and symptoms include weakness, tiredness, dizziness, low blood pressure that falls further when standing ( orthostatic hypotension ), cardiovascular collapse, muscle aches, nausea, vomiting, and diarrhea.[en.wikipedia.org]
Refractory Shock
  • shock, poor response to inotropes/pressors fever confusion CHRONIC ADRENAL INSUFFICIENCY GENERAL: weight loss, arthralgia, myalgia CNS: fatigue, anorexia, mood change CVS: postural hypotension, syncope, salt craving SKIN: pigmentation, vitiligo ELECTROLYTES[lifeinthefastlane.com]
Purpura
  • April 22, 2019 OVERVIEW Types: primary, secondary and tertiary acute/chronic Primary Addison’s destruction of 90% of adrenal glands rare causes: autoimmune destruction, haemorrhage, tumour (breast and melanoma), infection (Tb, HIV, meningococcemia, purpura[lifeinthefastlane.com]
  • […] which I have reorganised and adapted here: Vascular aetiologies Infarction due to arterial embolism Infarction due to AAA Postpartum pituitary necrosis Infection Sepsis Tuberculosis Histoplasmosis Cytomegalovirus Coccidiomycosis Menigococcal sepsis, purpura[derangedphysiology.com]
Suggestibility
  • Access full-color images and more than 90 online-only topics at Expert Consult, as well as EBMs, Suggested Reading, Patient Teaching Guides, and additional algorithms.[books.google.com]
  • The pigmentation at presentation, suggesting elevated ACTH, goes against the possibility of adrenal suppression from exogenous steroid exposure.[edmcasereports.com]
  • There is no good clinical evidence to suggest that the dosage regimens ever need to be exceeded.[what-when-how.com]
  • An identification card outlining treatment is also suggested. Primary Adrenal Insufficiency (Addison’s disease) should have a normal life expectancy.[nadf.us]
  • In our patient, bilateral adrenal enlargement without calcification was observed, suggesting the diagnosis of primary adrenal TB.[omicsonline.org]
Meningism
  • Ferri’s popular "5 books in 1" format provides quick guidance on short QT syndrome, microscopic polyangiitis, fungal meningitis, and much more. This medical reference makes the answers you need even easier to find - anytime, anywhere.[books.google.com]
  • Infiltration or infection - eg, sarcoidosis, haemachromatosis, lymphocytic hypophysitis, TB, meningitis.[patient.info]

Workup

  • Autoimmune workup If the diagnosis of Addison’s appears to be a part of a larger autoimmune pathology, one should include a workup for other endocrine gland dysfunctions.[pedclerk.bsd.uchicago.edu]
  • Addison Disease workup at eMedicine Further reading [ edit ] Bornstein, SR; Allolio, B; Arlt, W; Barthel, A; Don-Wauchope, A; Hammer, GD; Husebye, ES; Merke, DP; Murad, MH; Stratakis, CA; Torpy, DJ (February 2016).[en.wikipedia.org]
  • Further workup of anemia revealed hypochromic cells with anysocytosis on peripheral blood smear, serum iron 20 µg/dL, total iron binding capacity 108 µg/dL and iron saturation 22%.[asean-endocrinejournal.org]
Hyponatremia
  • […] deficiency) due to salt wasting from mineralocorticoid deficiency Secondary disease: Hyponatremia alone.[openanesthesia.org]
  • (AI): Manifestations usually begin in the first 48 hours after steroid medication has been discontinued Similar to primary AI except that hyperpigmentation and dehydration are absent; Gastrointestinal (GI) symptoms and hypotension are less prominent Hyponatremia[specialty.mims.com]
  • Hyperkalemia and hyponatremia with a normal anion gap metabolic acidosis will be a feature of mineralocorticid deficiency, and will resemble the wanton use of spironolactone.[derangedphysiology.com]
  • Hyponatremia and hyperkalemia may also result form chronic renal insufficiency. Diagnosis Addison’s requires a high degree of suspicion and investigation.[pedclerk.bsd.uchicago.edu]
  • Although there are classic clinical signs (eg, fatigue, orthostatic hypotension, hyperpigmentation, hyponatremia, hyperkalemia, and hypoglycemia) of adrenal insufficiency, its early clinical presentation is most commonly vague and undefined, requiring[ncbi.nlm.nih.gov]
Normocytic Anemia
  • Laboratory findings: CBC: normochromic, normocytic anemia, relative lymphocytosis with increased eosinophil count Acid-base: Mild metabolic acidosis Renal function: Prerenal azotemia Electrolytes: Primary disease: Hyponatremia and hyperkalemia (aldosterone[openanesthesia.org]

Treatment

  • The spread on hypertension will be revised and updated to reflect the fact that biochemistry is used as much or more in guiding treatment as it is in screening for secondary hypertension.[books.google.com]
  • The percent of the zona glomerulosa successfully destroyed by the cryo-treatment was highly variable between rats.[cornerstone.lib.mnsu.edu]
  • Treatment may also include taking a medication that helps restore the body's level of sodium and potassium.[stanfordchildrens.org]
  • Treatment may also include taking fludrocortisone, a drug that helps restore the body's level of sodium and potassium.[jerseyshoreuniversitymedicalcenter.com]

Prognosis

  • […] adrenalitis): enlargement of both adrenal glands, with necrotic centers and peripheral enhancing rims chronic : both adrenal glands appear small and atrophic, associated with calcifications ( adrenal calcification ) in granulomatous adrenalitis Treatment and prognosis[radiopaedia.org]
  • The prognosis for any patient with adrenal insufficiency will depend on the underlying cause. In those patients in whom the prognosis is not affected by the underlying pathology, replacement therapy should result in a return to health.[patient.info]
  • Prognosis - Addison's disease With proper medication, especially hormone replacement therapy, patients can expect to live relatively normal lives. Treatment - Addison's disease Corticosteroids to replace cortisols not secreted by the adrenal glands.[checkorphan.org]

Etiology

  • Overview Chronic Adrenocortical Insufficiency can be caused by a variety of etiologies.[pathwaymedicine.org]
  • Abstract Since Addison's classic and comprehensive description of the disease bearing his name, 1, 2 accepted etiologic factors have included tuberculosis and cytotoxic contracted adrenals (atrophy) almost exclusively.[annals.org]
  • Secondary adrenal insufficiency due to lack of stimulation of the gland is a more common etiology overall.[radiopaedia.org]
  • […] or equivalent for 4 weeks) or chronic glucocorticoid cream or inhaler application or long-lasting glucocorticoid injections into joints Tertiary AI is the inability of the hypothalamus to produce sufficient amount of corticotropin releasing hormone Etiology[specialty.mims.com]

Epidemiology

  • Epidemiology [ 1, 2 ] Primary insufficiency - this is a relatively rare condition. The annual incidence is about 1 in 10,000 people, with a prevalence in the UK of about 8,400. Across Europe, prevalence is estimated as 93-144 per million.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Furthermore, understanding the pathophysiology of the HPA axis gives great insight into its normal control. 2014 American Physiological Society. Compr Physiol 4:739‐769, 2014.[comprehensivephysiology.com]
  • The pathophysiology of this is not yet clear. It involves reduction in the production of glucocorticoids as well as reduced effect.[patient.info]
  • […] the body, especially lung ), hemorrhage (e.g. in Waterhouse–Friderichsen syndrome or antiphospholipid syndrome ), particular infections ( tuberculosis, histoplasmosis, coccidioidomycosis ), or the deposition of abnormal protein in amyloidosis. [22] Pathophysiology[en.wikipedia.org]
  • Addison disease can be part of the autoimmune polyglandular syndromes (type 1 and 2), or it may present as an isolated disorder. 1 This article focuses on the diagnosis and treatment of Addison disease as an isolated disorder, with a focus on the pathophysiology[aafp.org]

Prevention

  • Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets[books.google.com]
  • Preincubation of the microsomes with antisera to the 17 alpha-hydroxylase P-450 isozyme (P-450(17 alpha,lyase)) decreased 17 alpha-hydroxylase but not 21-hydroxylase activity and prevented the degradation of P-450 by 7 alpha-thio-SL.[molpharm.aspetjournals.org]
  • […] of HIV HIV Transmission and Prevention in Specific Populations Systematic Review of HIV Behavioral Prevention Research in African Americans Lynae A.[hivinsite.ucsf.edu]
  • There is no way to prevent Addison’s disease.[healthcommunities.com]
  • […] the immune response, especially cell-mediated immune responses . [ Discussion of mechanism ] For this reason glucocorticoids are widely used in therapy: to reduce the inflammatory destruction of rheumatoid arthritis and other autoimmune diseases to prevent[biology-pages.info]

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