ABSTRACT
Four types of adrenal dysfunction can occur in CCU patients: hypoadrenocorticism, hyperadrenocorticism, pheochromocytoma, and postoperative adrenalectomy complications. The normal hypothalamic-pituitary-adrenal axis is important in the adaptive response to stress. Corticotropin-releasing hormone (CRH) is released by cells in the paraventricular nucleus of the hypothalamus. In response to CRH, adrenocorticotropic hormone is released from the pituitary gland to stimulate the adrenal gland. Lack of mineralocorticoid secretion can cause-life threatening hyperkalemia, hyponatremia, and severe hypovolemia resulting in weakness and collapse. Lack of glucocorticoids may cause depressed mentation, lethargy, anorexia, and inability to respond to stress. Hypoadrenocorticism can often be tentatively diagnosed on the basis of history, clinical signs, and routine laboratory findings. Hyperadrenocorticism is usually medically treated with mitotane if the cause is pituitary dependent and with adrenalectomy if the cause is adrenal tumor. Adrenalectomy has a good prognosis if the tumor is benign. Invasive adrenal adenocarcinomas carry a grave prognosis because complete surgical resection is not possible.
