Adrenalectomy adrenal insufficiency

Cortisone acetate and hydrocortisone are usually the corticoids of choice for replacement therapy in patients with primary adrenocortical insufficiency (such as Addison s disease), or after adrenalectomy where both glucocorticoid and mineralo-corticoid replacement is needed. In secondary adrenal insufficiency, associated with inadequate corticotrophin (ACTH) secretion, glucocorticoid replacement alone is usually adequate [62]. 

Because of the high increase in toxicity of L-tryptophan in animals with adrenalectomy or induced adrenal insufficiency, administration of high doses must be avoided in certain humans, patients with adrenal insufficiency, in neonates, and in pregnant women. 

REPLACEMENT THERAPY Adrenal insufficiency can result from structural or functional lesions of the adrenal cortex (primary adrenal insufficiency or Addison s disease) or from structural or functional lesions of the anterior pituitary or hypothalamus (secondary adrenal insufficiency). In developed countries, primary adrenal insufficiency most frequently is secondary to autoimmune adrenal disease, whereas tuberculous adrenalitis is the most frequent etiology in underdeveloped countries. Other causes include adrenalectomy, bilateral adrenal hemorrhage, neoplastic infiltration of the adrenal glands, acquired immunodeficiency syndrome, inherited disorders of the steroidogenic enzymes, and X-Unked adrenoleukodystrophy. Secondary adrenal insufficiency resulting from pituitary or hypothalamic dysfunction generally presents in a more insidious manner than does the primary disorder, probably because mineralocorticoid biosynthesis is preserved. 

In addition to their natural hormonal actions, the adrenocorticoids have many clinical uses. Glucocorticoids and mineralocorticoids may be used for the treatment of adrenal insufficiency (hypoadrenalism), which results from failure of the adrenal glands to synthesize adequate amounts of the hormones. Adrenocorticoids also are used to maintain patients who have had partial or complete removal of their adrenal glands or adenohypophysis (adrenalectomy and hypophysectomy, respectively). Glucocorticoids can cross the placenta and can be distributed into milk. 

The medication cannot be discontinued a bilateral adrenalectomy means that all the hormones normally produced by the adrenal glands must be replaced. The client now has adrenal insufficiency (Addison s disease). 

Adrenal insufficiency, see also under Adrenalectomy diagnosis, VI, 316, 317 symptoms, VI, 30 312 treatment, VI, 317-319 Adrenal tumors,... 

Drugs with mineralocorticoidlike activity (aldosterone agonists) are frequently administered as replacement therapy whenever the natural production of mineralo-corticoids is impaired. Mineralocorticoid replacement is usually required in patients with chronic adrenocortical insufficiency (Addison disease), following adrenalectomy, and in other forms of adrenal cortex hypofunction. These conditions usually require both mineralocorticoid and glucocorticoid replacement. 

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