can lead to hypotension, shock and death if the individual is stressed – for example, by operation, infection,trauma

is due most commonly to ACTH (corticotropin) deficiency caused by suppression of adrenocortical function following the use of systemic corticosteroids (secondary hypoadrenocorticism); occasionally by acquired adrenal disease (primary hypoadrenocorticism); and rarely, by a congenital defect in corticosteroid biosynthesis (congenital adrenal hyperplasia)

ADRENOCORTICAL HYPOFUNCTION

caused by autoantibodies to the adrenal cortex, leading to adrenocortical atrophy and failed hormone secretion – cortisol (hydrocortisone) and aldosterone

Clinical featuresAnorexia, nausea and vomiting HypotensionSkin and mucosal pigmentationWeaknessWeight losslack of adrenocortical reserve makes patients

vulnerable to any stress such as infection, trauma, surgery

Primary hypoadrenocorticism (Addison disease)

Diagnosis of hypoadrenocorticism is confirmed by: hypotension;

sometimes, low plasma sodium and raised potassium; plasma glucose

assay (hypoglycaemia is common); and low plasma cortisol levels and depressed cortisol responses to ACTH stimulation

Serum should be tested for autoantibodies to various tissues,

especially endocrine glands, and other investigations may be needed, including radiography or CT or MRI scans of the skull (for pituitary abnormalities), chest (for tuberculosis) or abdomen (for adrenal calcification suggestive of tuberculosis or a mycosis).

General management

CS should generally be avoided unless patient has had corticosteroid cover

GA is obviously a matter for expert anaesthetist in hospital

For dental surgery under LA, glucocorticoid dose should be

doubled (up to 20 mg hydrocortisone) 1 hour before surgery After the procedure, the dose of oral medication is doubled for 24 hours, and then normal dose is reinstatedBrown or black pigmentation of mucosa is seen in

over 75% of patients with Addison disease

Dental aspects

can be caused by corticosteroid therapy and ACTH deficiency as a result of hypothalamic or pituitary disease

Secondary adrenocortical insufficiency

Adrenocortical hyperfunction may lead to release of excessive:

glucocorticoids (Cushing disease)mineralocorticoids (Conn syndrome or

hyperaldosteronism)androgens (congenital adrenal hyperplasia)

ADRENOCORTICAL HYPERFUNCTION

General aspectscaused by excess glucocorticoid production by

adrenal hyperplasia secondary to excess ACTH production by pituitary basophil adenomas

Cushing disease