Low cortisol production can be from
Destruction of adrenal gland (Addison's disease or primary hypocortisolism)
1.Infection like - tuberculosis, * autoimmunity.
Tumour destruction .
2.Hypofunction of pituitary (secondary hypocortisolism).
What are the clinical features of destruction of Adrenal glands?
loss of weight
loss of appetite
hyper-pigmentation of the skin
dizziness and low BP
decreased axillary and pubic hair and reduced libido in women.
could be associated with vitiligo i.e. patchy whitening of the skin.
Blood test may show low sodium, high potassium and low haemoglobin.
How do we confirm the destruction of adrenal glands?
Blood investigations include ,
Low blood sodium,
High blood potassium,
Low morning cortisol.
Finding low blood cortisol, which fails to increase after injection of synacthen is diagnostic of Addison I s disease. This test is called short synacthen test.
Protocol for Short synacthen test
1.Fasting blood sample for Cortisol at 8am
2.Inj.Synacthen 250mg 1M
3.30 mins later and 60 mins later blood for Cortisol.
End of test
CT scan - small Adrenal,
often with calcification.