HYPERCORTISOLISM (cushing's syndrome)
✿ Acth-independent (1°)
✧ adrenocortical tumor
⁎ adenomas
⁎ carcinomas
⁎ hyperplasias
✿ Exogenous glucocorticoids
✧ iatrogenic
✧ factitious
✿ Acth-dependent (2°)
✧ acth overproduction
⁎ corticotroph adenoma (cushing's disease)
✧ ectopic acth secretion
⁎ neuroendocrine tumors
⁎ small-cell carcinomas
✧ ectopic crh secretion
HYPOCORTISOLISM (adrenal insufficiency)
✿ 1° adrenal insufficiency (addison's disease)
✧ autoimmune
⁎ isolated autoimmune adrenalitis
⁎ polyglandular autoimmune syndromes
✧ infection
⁎ tuberculosis
⁎ histoplasmosis
⁎ paracoccidioidomycosis
⁎ hiv/aids
⁎ syphillis
⁎ african trypanosomiasis
✧ hemorrhage
⁎ waterhouse-friderichsen syndrome
⁎ hyper/hypocoagulopathy (anticoagulant, thromboembolism, antiphospholipid syndrome)
⁎ severe stress (trauma, postop, sepsis)
✧ drugs
⁎ antifungals (ketoconazole, fluconazole)
⁎ rifampin
⁎ phenytoin
⁎ barbiturates
⁎ etomidate
⁎ suramin
✧ infiltration
⁎ metastatic cancer
⁎ lymphoma
✧ congenital
⁎ adrenoleukodystrophy/myeloneuropathy
⁎ familial glucocorticoid deficiency
⁎ familial glucocorticoid resistance
⁎ defective cholesterol metabolism
✿ 2° adrenal insufficiency
✧ Isolated acth deficiency
⁎ autoimmune
⁎ gene mutation
⁎ traumatic brain injury
✧ Acth resistance
⁎ megestrol acetate
⁎ opioids
✧ Hypopituitarism
⁎ pituitary dysfunction
⁎ hypothalamus dysfunction
✧ Cortisol-binding globulin deficiency
✿ 3° adrenal insufficiency
✧ Isolated crh deficiency
⁎ chronic glucocorticoid use
⁎ history of cushing's syndrome
✧ Hypothalamus dysfunction
HYPOALDOSTERONISM
✿ Decreased aldosterone production
✧ primary adrenal insufficiency
✧ severe illness
✧ drugs
⁎ angiotensin inhibitors
⁎ chronic heparin
✧ congenital
⁎ 21-hydroxylase deficiency
⁎ isolated hypoaldosteronism
⁎ pseudohypoaldosteronism type 2 (gordon's syndrome)
✿ Low renin activity
✧ renal disease
✧ drugs
⁎ direct renin inhibitors
⁎ nsaids
⁎ calcineurin inhibitors
✧ volume expansion
HYPERALDOSTERONISM
✿ Aldosterone overproduction (1°)
✧ aldosterone-producing tumors
⁎ adenomas
⁎ carcinomas
⁎ ectopic tumors
✧ bilateral adrenal hyperplasia
✧ familial hyperaldosteronism
✧ unilateral adrenal hyperplasia
✿ Renin hypersecretion (2°)
✧ diuretics
✧ renovascular hypertension
✧ renin-secreting tumors
✿ Mineralocorticoid excess
✧ congenital adrenal hyperplasia
✧ licorice
