Secondary adrenal insufficiency classification: Difference between revisions
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*'''Tertiary adrenal insufficiency''' | *'''Tertiary adrenal insufficiency''' | ||
It is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes can include brain tumors and sudden withdrawal from long-term exogenous [[steroid use]] (which is the most common cause). | It is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes can include brain tumors and sudden withdrawal from long-term exogenous [[steroid use]]<ref name="pmid24715566">{{cite journal |vauthors=Raff H, Sharma ST, Nieman LK |title=Physiological basis for the etiology, diagnosis, and treatment of adrenal disorders: Cushing's syndrome, adrenal insufficiency, and congenital adrenal hyperplasia |journal=Compr Physiol |volume=4 |issue=2 |pages=739–69 |year=2014 |pmid=24715566 |pmc=4215264 |doi=10.1002/cphy.c130035 |url=}}</ref> (which is the most common cause). | ||
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{{familytree | | | | | | | | | A01 | | | | | |A01= '''Adrenal Insufficiency'''}} | {{familytree | | | | | | | | | A01 | | | | | |A01= '''Adrenal Insufficiency'''}} | ||
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{{familytree |boxstyle=text-align: left | | C01 | | | | | C02 | | | | | C03 |C01=•[[Addison's disease]]<br>•Autoimmune adrenalitis<br>•Idiopathic|C02= '''Hypopituitarism'''<br> •Tumors-[[Craniopharyngioma]]<br> •Infections- [[Tuberculosis]], [[Histoplasmosis]] <br>•Pituitary infarction-[[Sheehan's syndrome]], Pituitary apoplexy<br>•Removal of pituitary due to metatstasis<br>•Lymphycytic hypophysitis<br>•Head trauma<br>•Intracranial artery aneurysms<br>'''Drugs'''<br>•Megestrol<br>•Opiates- Codeine, Morphine|C03=Hypothalamic-Pituitary axis (HPA) suppression<br> • Chronic High-dose steroids <br>• Abrupt withdrawal of Steroids <br> }} | {{familytree |boxstyle=text-align: left | | C01 | | | | | C02 | | | | | C03 |C01=•[[Addison's disease]]<br>•Autoimmune adrenalitis<br>•Idiopathic|C02= '''Hypopituitarism'''<br> •Tumors-[[Craniopharyngioma]]<br> •Infections- [[Tuberculosis]]<ref name="pmid21509318">{{cite journal |vauthors=Al-Mamari A, Balkhair A, Gujjar A, Ben Abid F, Al-Farqani A, Al-Hamadani A, Jain R |title=A case of disseminated tuberculosis with adrenal insufficiency |journal=Sultan Qaboos Univ Med J |volume=9 |issue=3 |pages=324–7 |year=2009 |pmid=21509318 |pmc=3074785 |doi= |url=}}</ref><ref name="UpadhyaySudhindra2014">{{cite journal|last1=Upadhyay|first1=Jagriti|last2=Sudhindra|first2=Praveen|last3=Abraham|first3=George|last4=Trivedi|first4=Nitin|title=Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland|journal=International Journal of Endocrinology|volume=2014|year=2014|pages=1–7|issn=1687-8337|doi=10.1155/2014/876037}}</ref> | ||
, [[Histoplasmosis]] <ref name="pmid23777028">{{cite journal| author=Bhansali A, Das S, Dutta P, Walia R, Nahar U, Singh SK et al.| title=Adrenal histoplasmosis: unusual presentations. | journal=J Assoc Physicians India | year= 2012 | volume= 60 | issue= | pages= 54-8 | pmid=23777028 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23777028 }} </ref><br>•Pituitary infarction-[[Sheehan's syndrome]], Pituitary apoplexy<br>•Removal of pituitary due to metatstasis<br>•Lymphycytic hypophysitis<br>•Head trauma<br>•Intracranial artery aneurysms<br>'''Drugs'''<br>•Megestrol<br>•Opiates- Codeine, Morphine|C03=Hypothalamic-Pituitary axis (HPA) suppression<ref name="pmid24715566">{{cite journal |vauthors=Raff H, Sharma ST, Nieman LK |title=Physiological basis for the etiology, diagnosis, and treatment of adrenal disorders: Cushing's syndrome, adrenal insufficiency, and congenital adrenal hyperplasia |journal=Compr Physiol |volume=4 |issue=2 |pages=739–69 |year=2014 |pmid=24715566 |pmc=4215264 |doi=10.1002/cphy.c130035 |url=}}</ref><br> • Chronic High-dose steroids <br>• Abrupt withdrawal of Steroids <br> }} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 20:37, 19 September 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].
Classification
Adrenal insufficiency is classified into 3 types based on the level of impairment.
- Primary adrenal insufficiency
It is due to impairment of the adrenal gland, 80% due to an autoimmune disease called Addison's disease or autoimmune adrenalitis. One subtype is called idiopathic, meaning of unknown cause. Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.
- Secondary adrenal insufficiency
It is caused by impairment of the pituitary gland or hypothalamus. The principal causes include pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced); and Sheehan's syndrome, which is associated with impairment of only the pituitary gland.
- Tertiary adrenal insufficiency
It is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes can include brain tumors and sudden withdrawal from long-term exogenous steroid use[1] (which is the most common cause).
| Adrenal Insufficiency | |||||||||||||||||||||||||||||||||||||
| Primary adrenal insufficiency | Secondary adrenal insufficiency | Tertiary adrenal insufficiency | |||||||||||||||||||||||||||||||||||
| •Addison's disease •Autoimmune adrenalitis •Idiopathic | Hypopituitarism •Tumors-Craniopharyngioma •Infections- Tuberculosis[2][3] , Histoplasmosis [4] •Pituitary infarction-Sheehan's syndrome, Pituitary apoplexy •Removal of pituitary due to metatstasis •Lymphycytic hypophysitis •Head trauma •Intracranial artery aneurysms Drugs •Megestrol •Opiates- Codeine, Morphine | Hypothalamic-Pituitary axis (HPA) suppression[1] • Chronic High-dose steroids • Abrupt withdrawal of Steroids | |||||||||||||||||||||||||||||||||||
References
- ↑ 1.0 1.1 Raff H, Sharma ST, Nieman LK (2014). "Physiological basis for the etiology, diagnosis, and treatment of adrenal disorders: Cushing's syndrome, adrenal insufficiency, and congenital adrenal hyperplasia". Compr Physiol. 4 (2): 739–69. doi:10.1002/cphy.c130035. PMC 4215264. PMID 24715566.
- ↑ Al-Mamari A, Balkhair A, Gujjar A, Ben Abid F, Al-Farqani A, Al-Hamadani A, Jain R (2009). "A case of disseminated tuberculosis with adrenal insufficiency". Sultan Qaboos Univ Med J. 9 (3): 324–7. PMC 3074785. PMID 21509318.
- ↑ Upadhyay, Jagriti; Sudhindra, Praveen; Abraham, George; Trivedi, Nitin (2014). "Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland". International Journal of Endocrinology. 2014: 1–7. doi:10.1155/2014/876037. ISSN 1687-8337.
- ↑ Bhansali A, Das S, Dutta P, Walia R, Nahar U, Singh SK; et al. (2012). "Adrenal histoplasmosis: unusual presentations". J Assoc Physicians India. 60: 54–8. PMID 23777028.