Adrenocortical insufficiency

The neurohormonal control of reproduction involves a network of central and peripheral signals in the hypothalamic-pituitary-gonadal axis. The gonadotropin-releasing hormone (GnRH) system plays a crucial part in this axis.

Integration of multiple signals ultimately results in neuronal release of GnRH, which then travels via the hypothalamic–hypophyseal portal circulation to the anterior pituitary gland, where it binds to the GnRH receptor 1 and upregulates synthesis and secretion of two pituitary hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). GnRH secretion is pulsatile with discrete bursts of GnRH affecting the release of pulses of LH and FSH by the pituitary. This chapter describes medical conditions as well as endogenous and exogenous factors that result in abnormalities of this complex hypothalamic-pituitary axis.

Autoimmune adrenalitis, or autoimmune Addison disease (AAD), is the most prevalent cause of primary adrenal insufficiency in the developed world. AAD is rare and can easily be misdiagnosed as other conditions. The diagnosis depends on demonstrating inappropriately low cortisol production and the presence of high titers of adrenal cortex autoantibodies (ACAs), along with excluding other causes of adrenal failure using other tests as necessary. The treatment corticosteroid replacement, and the prognosis following the treatment is the same as the normal population. Spontaneous recovery of adrenal function has been described but is rare.