Endocrinology MCQ Answer 042

The Correct Answer is B. Autoimmune adrenalitis

There are a number of processes that can result in the destruction of the adrenal glands.

1. Autoimmune Adrenalitis – (80%) both cell-mediated and antibody-mediated autoimmunity are directed against the adrenal cells. Histologically, there are lymphocytic infiltrations, then development of fibrosis and loss of functioning adrenal tissue. With loss of 90% of all adrenal tissue, you get adrenal insufficiency. In 80% of these patients, anti-adrenal antibodies are present in the blood. On CT, small, non-calcified adrenal glands are evident. This can occur as a solitary disorder or associated with other endocrine autoimmune phenomena.

* Polyglandular autoimmune syndrome I: [An autosomal recessive disease] Addison’s disease is associated with hypoparathyroidism and fungal infections of the mouth and nails. Hypoparathyroidism generally presents first then the person develops Addison’s disease. Usually, the entire picture is present by the time the person is 15-16 years old.



* Polyglandular autoimmune syndrome II:[ Multiple mechanisms of inheritance] Addison’s disease is associated with type I Diabetes (due to autoimmune destruction of b-cells in the pancreas) and also autoimmune thyroid disease (i.e., Hashimoto’s thyroiditis which leads to hypothyroidism or Grave’s disease leading to hyperthyroidism.) Some patients with Addison’s disease also have pernicious anemia (also an autoimmune process.)



*In both of these disorders, there can also be autoimmune destruction of gonadal tissue leading to ovarian and testicular failure.

Category: