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Old 03-19-2012
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Question Adrenal crisis in suppressed HPA axis?

I don't get how a patient with HPA axis suppression due to chronic prednisone therapy can develop an adrenal crisis under an stressful situation even if his baseline glucocorticoid regime is maintained?

How can he develop an adrenal crisis if hi has glucocorticoids in his body? I understand that we have to give extra glucocorticoids to prevent this to happen, I just do not understand the physiophatology of what happens when we don't give this "extra" dose.

Can someone please help me to understand this?

"Disease is very old, and nothing about it has changed. It is we who change as we learn to recognize what was formerly imperceptible." JMC
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Old 03-19-2012
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when patients HPA axis is suppressed , and in any stressful situation like infection or emotional or physical we need cortisol , but since patients are taking a constant amount their cortisol level falls short , now since HPA is suppressed , no ACTH ..... leads to Adrenal crisis .....

hope this helps ......
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Old 03-20-2012
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Exogenous glucocorticoids through negative feedback inhibit ACTH secretion
Without ACTH zona reticularis and fasciculata undergo atrophy therefore there's no endogenous hormone secretion
Time is needed untill adrenal gland regains its normal size and restarts secretion

It could be due to inability to supply enough hormone during stress conditions
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Dr. Mexito (03-20-2012), monsalg2502 (03-20-2012)


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