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 is 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, causing 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 itself. Secondary and tertiary adrenal insufficiency result from dysfunction along the hypothalamic-pituitary axis, causing deficiency of just the glucocorticoid hormones.  Both secondary and tertiary adrenal insufficiency, collectively called central adrenal insufficiency, can also result from use of glucocorticoid drugs, such as prednisolone.

The recommended initial 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 prior to diagnostic evaluation.   Subsequent testing may help differentiate primary and secondary adrenal insufficiency and identify the etiology.

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Last Update: November 2018