Adrenal Insufficiency, Relative

Adrenal Insufficiency, Relative



Basic Information image



Definition


Relative adrenal insufficiency (RAI) is a condition in which the adrenal gland, notably the adrenal cortex, is unable to respond (ie, secrete cortisol) to an appropriate level given the stimulus. RAI is often observed in patients with critical illness such as sepsis, in which adrenal hypofunction is considered part of the multiple organ dysfunction complex.



Synonym(s)




• Adrenal exhaustion


• Adrenal hypofunction



Species, Age, Sex


Premature foals have been shown to have hypofunctional hypothalamic-pituitary-adrenal axis (HPAA) responses, possibly due to underdevelopment; however, foals with sepsis or severe stress may have RAI, with a reported incidence of up to 52%.



Risk Factors




• Critical illness such as systemic inflammatory response syndrome (SIRS), sepsis, septic shock, endotoxemia, and trauma


• Long-term administration of anabolic steroids


• Prematurity



Associated Conditions and Disorders




• SIRS


• Sepsis


• Septic shock


• Chronic stress responses


• Prematurity



Clinical Presentation



History, Chief Complaint


Variable, based on the primary disease or disorder that causes RAI



Physical Exam Findings




• Referable to the primary illness: SIRS, sepsis, endotoxemia, or prematurity.


• Neurologic impairment, seizures, collapse, or other findings may be related to specific electrolyte abnormalities.



Etiology and Pathophysiology




• Prolonged or severe systemic illness leads to HPAA stimulation to yield increased cortisol concentrations.


• Diseases causing systemic inflammation and hypotension significantly increase HPAA responses.


• Excessive stimulation of the adrenal cortex (notably the zona fasciculata) results in an inability to secrete cortisol at an appropriate concentration for the stimulus (eg, adrenocorticotropin [ACTH])


• HPAA underdevelopment associated with neonatal prematurity may result in similar findings.


• In humans, subnormal cortisol responses have been associated with refractory hypotension and correlated with nonsurvival in certain patient populations (eg, septic shock).



Diagnosis image



Differential Diagnosis


Absolute adrenal insufficiency (true hypoadrenocorticism; Addison’s disease), in which signs of mineralocorticoid deficiency exist, such as clinically relevant hyponatremia



Initial Database




• Accurate diagnosis of the primary illness


• Blood culture

• Complete blood count
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Adrenal Insufficiency, Relative

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