Clinical Analysis Of Adrenocortical Hypofunction

OBJECTIVE: To investigate the etiology and clinical characteristics ofprimary( Addison's disease)and secondary adrenocortical hypofunction. METHODS: To analyse the clinical data of 39 patients with adrenocortical hypofunction treated at The First Affiliated Hospital of Zhejiang University School of Medicine from February 2005 to February 2007.RESULTS: The patient's age ranged from 21 to 77 years (mean 45 years old). 39cases included 13 Addison's disease and 26 secondary adrenocortical hypofunction. 13 Addison's disease etiologically included 4 adrenal tuberculosis, 1 the polyglandular syndromes,2 POMES syndromes,3 idiopathic,2 remain unknown. 26 secondary adrenocortical hypofunction etiologically included 9 postpartum hemorrhaged, 7 postsurgical pituitary body, 4 emptysellasyndrome, 4 idiopathic, 2 remain unknown. The typical history and clinical findings of adrenocortical hypofunction include a longer history of malaise, fatigue, anorexia, weight loss, dizziness, orthostatic hypotension, vomiting, abdominal distention, abdominal pain and darkening of the skin. Patients may crave salt and develop unusual food preferences. such as drinking the brine surrounding pickles. The laboratory examinations included: diminished secretion of cortisone, hypopotassemia, hyponatremia, hypoglycemia, hyperkalemia, and anemia. Abnormity can be found in adrenal CT and MRI of pituitary gland. Treatment of adrenal insufficiency involves physiologic replacement of the deficient hormones. For chronic therapy, oral hydrocortisone provides glucocorticoid replacement that can be easily titrated and given as divided doses during the day to grossly recapitulate the normal diurnal pattern of cortisol secretion. Patients should add the high dose of Cortisol temporarily when they are at stress.