Hello and welcome to the zero to finals podcast. My name is Tom and in this episode I'm going to be

talking to you about adrenal insufficiency. And you can find written notes on this topic at zero

to finals.com slash endocrinology or in the endocrinology section of the zero to finals medicine book.

So let's get straight into it.

Adrenal insufficiency is where the adrenal glands do not produce enough steroid hormones,

particularly cortisol and aldosterone.

Steroid hormones are essential for life.

Therefore, the condition is life-threatening unless the hormones are replaced.

Addison's disease refers specifically to when the adrenal glands have been damaged,

resulting in reduced cortisol and aldosterone secretion.

This is called primary adrenal insufficiency.

The most common cause is autoimmune.

Secondary adrenal insufficiency results from inadequate adrenocortocotropic hormone or ACT-H

and a lack of stimulation of the adrenal glands leading to low

cortisol. This is the result of loss or damage to the pituitary gland. Secondary adrenal insufficiency

can be due to tumours, for example pituitary adenomas, surgery to the pituitary, radiotherapy,

Sheehan syndrome, which is where major postpartum hemorrhage causes avascular necrosis of the

pituitary gland, and trauma. Tertiary adrenal insufficiency results from inadequate corticotropin releasing hormone, or CRH, from the

hypothalamus. This is usually the result of patients taking long-term oral steroids for more than

three weeks, causing suppression of the hypothalamus via negative feedback.

When the exogenous steroids, and remember exogenous means originating outside the body,

are suddenly withdrawn, the hypothalamus does not wake up fast enough, and the endogenous

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