Adrenal atrophy overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]
Overview
Adrenal atrophy is the shrinkage of adrenal gland due to reduce in size and number of adrenal gland cells.
Historical Perspective
We have had many famous cases of adrenal atrophy like president John F. Kennedy, king Henry VIII.
Classification
There is no established system for the classification of adrenal atrophy. However, some authors have classified it by causes.
Pathophysiology
The adrenal glands produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions. Adrenal atrophy may be caused by a loss of ACTH and trophic support of the adrenal cortex or direct damage to the tissue due to exogenous corticosteroid overuse or an endocrine disease, affecting the glands.
Causes
Adrenal atrophy may be caused by a loss of ACTH and trophic support of the adrenal cortex or direct damage to the tissue.
Adrenal atrophy differential diagnosis
There are some conditions that cause salt wasting, nausea, vomiting, hyponatremia, hyperkalemia and finally adrenal hormone imbalance which should be differentiated from adrenal atrophy.
Epidemiology and Demographics
Generally, secondary adrenal atrophy is more common than primary adrenal atrophy and is more common in women. Clinical manifestations occur in 30s to 50s in primary and in 60s in secondary adrenal atrophy.
Risk Factor
There are no established risk factors for adrenal atrophy.
Screening
There is insufficient evidence to recommend routine screening for adrenal atrophy. However, the adrenal-hypopituitary axis can be evaluated with sodium, potassium, renin, aldosterone, cortisol, DHEA, ACTH, and CRH levels.
Natural history, complications and prognosis
Adrenal atrophy is mainly due to the prolonged malfunction of the adrenal gland. If left untreated, the patients are mainly at risk of a lethal condition, called adrenal crisis. Common complications of the adrenal atrophy and its malfunction include hypoglycemia, dehydration, weight loss, and disorientation. Prognosis is generally poor, due to the irreversibility of atrophy.
Diagnosis
History and Symptoms
The most common signs and symptoms of adrenal atrophy are fatigue, weight loss, salt craving, abdominal pain and myalgia.
Physical Examination
In the physical examination the patients may have hypotension, hyperpigmentation, depigmentation in autoimmune cases.
Laboratory Findings
The labs include random cortisol, serum ACTH, aldosterone and renin, potassium and sodium, ACTH stimulation test and CRH stimulation test.
Electrocardiogram
There are no specific ECG changes due to adrenal atrophy. However it consequences such as hyperkalemia may change ECG.
X-ray
There are no x-ray findings associated with adrenal atrophy.
Ultrasound
The adrenal glands can be studied in ultrasound imaging and each abdominal ultrasound. Any new incidental mass, larger than 1cm should be evaluated with CT-scan or MRI.
CT scan
A CT of the adrenal glands can be used to check for structural abnormalities of the adrenal glands.
MRI
An MRI of the pituitary can be used to check for structural abnormalities of the pituitary.
Other Imaging Findings
There are no other imaging findings associated with adrenal atrophy.
Other Diagnostic Studies
There are no other diagnostic studies associated with adrenal atrophy.
Treatment
Medical Therapy
Treatment of adrenal atrophy is conservative. In case of adrenal crisis IV fluid and steroid are recommended. For long-term management supplementing with steroid and mineralocorticoid is necessary.
Surgery
Surgery can be done in case of micro or macro adenomas of brain or other glandular tumors that may lead to adrenal atrophy.
Primary Prevention
Primary prevention of the adrenal atrophy consists of avoiding overuse of exogenous corticosteroid drugs.
Secondary Prevention
The secondary prevention of the adrenal atrophy is also known as early diagnosis of any steroid or mineralocorticoid deficiency in the body and its early appropriate treatments.
Cost-Effectiveness of Therapy
There is no cost-effectiveness of therapy for adrenal atrophy.
Future or Investigational Therapies
There are no future or investigational therapies for adrenal atrophy.