Nebenniereninsuffizienz

· Nebenniereninsuffizienz [[Image:{{{Image}}}|190px|center|]] Endocrine system Latin glandula suprarenalis Gray's subject #277 1278 System Endocrine MeSH A06.407.071 Adrenal gland Adrenal insufficiency is a condition in which the adrenal glands, located above the kidneys, do not produce adequate amounts of steroid hormones (chemicals produced by the body that regulate organ function), primarily cortisol, but may also include impaired aldosterone production (a mineralcorticoid) which regulates sodium, potassium and water retention.[1][2] Craving for salt or salty foods due to the urinary losses of sodium is common.[3] Addison's disease is the worst degree of adrenal insufficiency, which if not treated, severe abdominal pains, diarrhea, Erbrechen, profound muscle weakness and fatigue, extremely low blood pressure, weight loss, kidney failure, changes in mood and personality and shock may occur (adrenal crisis).[4] An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, or severe infection. Death may quickly follow.[4].  Adrenal insufficiency can also occur when the hypothalamus or the pituitary gland, both located at the base of the skull, doesn't make adequate amounts of the hormones that assist in regulating adrenal function.[1][5][6] This is called secondary adrenal insufficiency and is caused by lack of production of ACTH in the pituitary or lack of CRH in the hypothalamus.[7] Inhalt 1 Types 2 Bewirkt 3 Symptome 4 Diagnose 5 Behandlung 6 Simple diagnostic chart 7 Siehe auch 8 Referenzen 9 External links Types Adrenal impairment (primary adrenal insufficiency) Idiopathic adrenal insufficiency Addison's disease (autoimmune adrenalitis) Congenital adrenal hyperplasia Adrenal tumor adenoma Pituitary or hypothalamus impairment (secondary adrenal insufficiency)[8] Pituitary micro adenoma pituitary macro adenoma Hypothalamic tumor Sheehan's syndrome (associated only with pituitary impairment) Causes Autoimmune (may be part of a polyglandular autoimmune disorder which can include type I Diabetes Mellitus, autoimmune thyroid disease (also known as autoimmune thyroiditis, Hashimoto's thyroiditis and Hashimoto's disease)[9] Adrenoleukodystrophy[10] Discontinuing corticosteroid therapy without tapering the dosage (severe adrenal suppression with ACTH suppression) Illness or any other forms of stress kidney injury environmental genetics Head injury Radiation Surgery infections (eg, meningitis) congenital Hypopituitarism congential hypoadrenalism Symptoms The person may show symptoms of hypoglycemia, dehydration, weight loss and disorientation. They may experience weakness, tiredness, Schwindel, low blood pressure that falls further when standing (orthostatic hypotension), muscle aches, nausea, Erbrechen, and diarrhea. These problems may develop gradually and insidiously. Addison's can present with tanning of the skin which may be patchy or even all over the body and in some cases a person with light skin can look so dark people mistake them for being from another country. Characteristic sites of tanning are skin creases (z.B. of the hands) and the inside of the cheek (buccal mucosa). Goitre and vitiligo may also be present.[4] Diagnosis If the person is in adrenal crisis, the ACTH stimulation test may be given. If not in crisis, cortisol, ACTH, aldosterone, renin, potassium and sodium are tested from a blood sample before the decision is made if the ACTH stimulation test needs to be performed. X-rays or CT of the adrenals may also be done.[1] Treatment Adrenal crisis Intravenous fluids[4] Intravenous steroid (Solu-Cortef or Solumedrol), later hydrocortisone, prednisone or methylpredisolone tablets[4] Rest Cortisol deficiency (primary and secondary) Adrenal cortical extract (usually in the form of a supplement, non prescription in the United States) Hydrocortisone (Cortef) (between 20 und 35 mg)[4] Prednisone (Deltasone) (7 1/2 mg) Prednisolone (Delta-Cortef) (7 1/2 mg) Methylprednisolone (Medrol) (6 mg) Dexamethasone (Decadron) (1/4 mg, some doctors prescribe 1/2 zu 1 mg, but those doses tend to cause side effects resembling Cushing's disease) Mineralcorticoid deficiency (low aldosterone) Fludrocortisone (Florinef) (To balance sodium, potassium and increase water retention)[4] Simple diagnostic chart Source of pathology CRH ACTH DHEA cortisol aldosterone renin Na K Causes5 hypothalamus (tertiary)1 low low low low3 low low low low tumor of the hypothalamus (adenoma), antibodies, environment, head injury pituitary (secondary) high2 low low low3 low low low low tumor of the pituitary (adenoma), antibodies, environment, head injury, surgical removal6, Sheehan's syndrome adrenal glands (primary)7 high high high low4 low high low high tumor of the adrenal (adenoma), stress, antibodies, environment, Addison's, injury, surgical removal 1 Automatically includes diagnosis of secondary (hypopituitarism) 2 Only if CRH production in the hypothalamus is intact 3 Value doubles or more in stimulation 4 Value less than doubles in stimulation 5 Most common, doesn't include all possible causes 6 Usually because of very large tumor (macroadenoma) 7 Includes Addison's disease See also Cushing's syndrome Insulin tolerance test Hypoadrenia References ↑ Jump up to: 1.0 1.1 1.2 Eileen K. Corrigan (2007). Adrenal Insufficiency (Secondary Addison's or Addison's Disease). NIH Publication No. 90-3054. ↑ MeSH Adrenal+Insufficiency ↑ Ten S, New M, Maclaren N (2001). Clinical review 130: Addison-Krankheit 2001. J. Klin. Endocrinol. Metab. 86 (7): 2909–22. ↑ Jump up to: 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Ashley B. Grossman, MD (2007). Addison's Disease. Adrenal Gland Disorders. 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External links Penn State University - Adrenal insufficiency CAH - Info on Congenital adrenal insufficiency v·d·e Endocrine pathology of psychological interest (E00-35) Schilddrüse Hypothyreose (Jodmangel, Kretinismus, Angeborene Hypothyreose, Kropf) - Hyperthyreose (Basedow-Basedow-Krankheit, Toxischer multinodulärer Kropf) - Thyreoiditis (De Quervain-Thyreoiditis, Hashimoto-Thyreoiditis) Pankreas Diabetes mellitus (Art 1, Art 2, Koma, angiopathie, Neuropathie, Retinopathie) - Zollinger-Ellison-Syndrom Nebenschilddrüse Hypoparathyreoidismus - Hyperparathyreoidismus hypophysäre Hyperfunktion (Akromegalie, Hyperprolaktinämie, ) - Hypopituitarismus Kallmann-Syndrom, Wachstumshormonmangel) - Hypothalamus-Hypophysen-Dysfunktion Nebennieren-Cushing-Syndrom) - Angeborene Nebennierenhyperplasie (durch 21-Hydroxylase-Mangel) - Bartter-Syndrom) - Nebenniereninsuffizienz (Addison-Krankheit) Keimdrüsen - 5-Alpha-Reduktase-Mangel - Hypogonadismus - Delayed puberty - Precocious puberty other - - Psychogenic dwarfism - Androgen insensitivity syndrome - v·d·e Endocrine system: hormones (Peptide hormones· Steroid hormones) Endocrine glands Hypothalamic- pituitary Hypothalamus GnRH· TRH· Dopamin· CRH· GHRH/Somatostatin· Melanin concentrating hormone Posterior pituitary Vasopressin· Oxytocin Anterior pituitary α (FSH FSHB, LH LHB, TSH TSHB, CGA) · Prolactin· POMC (CLIP, ACTH, MSH, Endorphins, Lipotropin) · GH Adrenal axis Adrenal cortex: aldosterone· cortisol· DHEA Adrenal medulla: epinephrine· norepinephrine Thyroid axis Thyroid: thyroid hormone (T3 and T4) · calcitonin Parathyroid: PTH Gonadal axis Testis: testosterone· AMH· inhibin Ovary: estradiol· progesterone· activin and inhibin· relaxin (pregnancy) Placenta: hCG· HPL· estrogen· progesterone Islet-Acinar Axis Pancreas: glucagon· insulin· amylin· somatostatin· pancreatic polypeptide Pineal gland Pineal gland: melatonin Non-end. glands Thymus: Thymosin (Thymosin α1, Thymosin beta) · Thymopoietin· Thymulin Digestive system: Stomach: gastrin· ghrelin· Duodenum: CCK· Incretins (GIP, GLP-1)  · secretin· motilin· VIP· Ileum: enteroglucagon·peptide YY· Liver/other: Insulin-like growth factor (IGF-1, IGF-2) Adipose tissue: leptin· adiponectin· resistin Skeleton: Osteocalcin Kidney: JGA (renin) · peritubular cells (EPO) · calcitriol· prostaglandin Heart: Natriuretic peptide (ANP, BNP) {| class="navbox collapsible nowraplinks" style="margin:auto; " [. v]·[. d]·[. e] M: END anat/phys/devp/horm noco (d)/cong/tumr, sysi/epon proc, drug (A10/H1/H2/H3/H5) |} Target-derived NGF, BDNF, NT-3 |}