Adrenal Insufficiency

Adrenal insufficiency, a potentially fatal condition in the case of adrenal crisis, is defined as hypofunction of the adrenal gland with decreased or absent hormone secretion. It can be classified as primary, secondary, or tertiary. Primary adrenal insufficiency (PAI), also known as Addison disease, is due to damage to or loss of adrenal tissue, which results in deficiency of all adrenocortical hormones. These hormones include mineralocorticoids, glucocorticoids, and androgens. Addison disease is most common in high-income countries. PAI can also be caused by​ congenital adrenal hyperplasia (CAH) (a group of rare genetic conditions) or other diseases that affect the adrenal gland. Secondary and tertiary adrenal insufficiency (known collectively as adrenal insufficiency) result from dysfunction along the hypothalamic-pituitary axis, which leads to deficiency of the glucocorticoid hormones.  Both secondary and tertiary adrenal insufficiency can also result from use of glucocorticoid drugs, such as prednisolone.

The recommended initial laboratory workup in the evaluation of adrenal insufficiency is the adrenocorticotropic hormone (ACTH) stimulation test. Patients in acute adrenal crisis, however, require prompt treatment and stabilization before diagnostic evaluation.   Subsequent testing may help differentiate primary and secondary adrenal insufficiency and identify the etiology.

Tabs Content
Content Review: 
December 2019

Last Update: December 2019