Step II secondary hypoadrenalism

[Jimmy1]

Is it due to ACTH resistance (giving increased ACTH, and decreased cortisol)
OR decreased ACTH production by the pituitary?


FA and UW seem to disagree on this one!

 

[Jimmy1]

I should probably add that I'm talking about inducing hypoadrenalism by stopping long-term corticosteroid treatment.

 

[Shane2150]

According to my second-year textbook, "when prolonged CS treatment is stopped, the adrenal is atrophic and unresponsive and the pt is at risk for acute adrenal insufficiency. The pituitary may not be able to secrete normal amounts of ACTH for as long as a month..." So it sounds like it is a problem with both ACTH production and the adrenal's ability to respond to it.

Hope this helps

 

[sophiejane]

According to my second-year textbook, "when prolonged CS treatment is stopped, the adrenal is atrophic and unresponsive and the pt is at risk for acute adrenal insufficiency. The pituitary may not be able to secrete normal amounts of ACTH for as long as a month..." So it sounds like it is a problem with both ACTH production and the adrenal's ability to respond to it.

Hope this helps

When all else fails...go back to basic science. 🙂 That's why I never sold those 2nd year books...

 

[ucbdancn00]

I should probably add that I'm talking about inducing hypoadrenalism by stopping long-term corticosteroid treatment.

just to add some other things that people have said and to help clarify if necessary

corticosteroids---> inhibit ACTH---> shut down of endogenous steroid production...

then when you stop the iatrogenic steroids...the adrenal isn't making anymore and there's none more circulating around---> acute adrenal insufficiency

i think there's a pneumonic that "one week of steroids, requires one month of tapering" or something like that..

hope this helps

ucb

 

[BlackNDecker]

Shane2150 is correct.

Long term steroid usage (actual duration not specified by OP) would result in adrenal atrophy. From this perspective, all the ACTH in the world wouldn't result in significant endogenous cortisol production...a la "ACTH resistance." I believe the preferred term is adrenal atrophy.

On the other hand, if the treatment regimen was short (albeit long enough to suppress Pituitary ACTH) then the hypoadrenalism would be secondary to decreased pituitary ACTH production.

The key here is how long the steroid treatment is...

 

[Jimmy1]

Thanks for all the great replies!!

When in doubt, ask SDN.

 

[sponch]

Shane is right on both counts. Long term glucocorticoid therapy causes both atrophy of the adrenal gland AND suppression of the HPA axis, both of which require considerable time to reestablish homeostasis. Thus, even if you have minimal adrenal atrophy, you would still have hypoadrenalism due to insufficient levels of corticotropin.