Addison's disease [Neurosurgery Wiki]

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====== Addison's disease ======

Primary adrenal insufficiency, also called Addison's disease, occurs when adrenal gland production of [[cortisol]] is chronically deficient, resulting in chronically elevated [[ACTH]] levels; when a [[pituitary tumor]] is the cause of elevated ACTH (from the anterior pituitary) this is known as [[Cushing's Disease]] and the constellation of signs and symptoms of the excess cortisol (hypercortisolism) is known as [[Cushing's syndrome]]. A deficiency of ACTH is a cause of secondary adrenal insufficiency. ACTH is also related to the circadian rhythm in many organisms.

Functional adrenocorticotropic hormone–secreting pituitary neuroendocrine tumors (ACTH-PAs) secrete inappropriate amounts of ACTH, which results in disorderly and excessive production of cortisol by the adrenal gland
((Aron DC, Findling JW, Tyrrell JB: Cushing's disease. Endocrinol Metab Clin North Am 16:705–730, 1987)).

[[Nonfunctioning pituitary macroadenoma]] (NFMA) patients suffer from altered sleep-wake rhythmicity. [[Hydrocortisone]] dependency may explain part of the decreased daytime functioning, but the independent influence of [[visual field defect]]s (VFD) and differences between [[Addison's disease]] (AD) and NFMA patients point towards a role for dysfunction of the adjacent [[suprachiasmatic nucleus]] (SCN)
((Joustra SD, Kruijssen E, Verstegen MJ, Pereira AM, Biermasz NR. Determinants
of altered sleep-wake rhythmicity in patients treated for nonfunctioning
pituitary macroadenomas. J Clin Endocrinol Metab. 2014 Dec;99(12):4497-505. doi: 
10.1210/jc.2014-2602. PubMed PMID: 25210880.
)).

===== Treatment =====
[[Glucocorticoid]] and [[mineralocorticoid]] must be replaced.