Adrenal Insufficiency Questions and answers

Adrenal Insufficiency Questions and answers
Adrenal Insufficiency - ✅✅Glucocorticoid deficient state

Frequently associated with other autoimmune diseases:

Vitiligo

Type 1 diabetes

Hashimoto's disease of the thyroid

Pernicious anemia

Celiac sprue



Primary Adrenal Insufficiency causes - ✅✅Autoimmune (Addison's disease most common 80%)

Adrenal hemorrhage: sepsis, trauma, emboli, ANTICOAGULANT THERAPY

INFECTIONS - TB, CMV, HIV

Metastatic lesions

Infiltrative disorders - Amyloidosis, Sarcoidosis, Hemochromatosis

Genetic syndromes: Congenital adrenal hyperplasia, adrenoleukodystrophy

Autoimmune DESTRUCTION OF ADRENAL CORTEX LEADS TO BOTH GLUCOCORTICOID AND
MINERALOCORTICOID DEFICIENCY (cortisol and aldosterone)



Primary Adrenal Insufficiency: Symptoms - ✅✅Weakness, fatigue and weight loss

Hyper pigmentation (due to pit. producing lots ACTH- which is precursor hormone - gets cleaved into
melanocytes stim hormone and ACTH. Lots of ACTH = lots of melanocytes= hyper pigmentation)

Hypotension

Hypoglycemia

Postural symptoms

Gastrointestinal symptoms



Primary adrenal Insufficiency:
Signs - ✅✅Weight loss (Failure to thrive or growth retardation) -100%

Hyperpigmentation- 90% (no tan lines - piigmented in palmar creases, buccal lining)

, Hypotension- 88%

Postural dizziness- 12%

Adrenal calcifications- 10%

Vitiligo- 5% (autoimmune destruction of melanocytes- sometimes goes along with adrenal insufficiency)



LAbS - ✅✅Electrolyte disturbances in general- 92%

Hyponatremia- 88%

Hyperkalemia-acidosis- 64%

hypoglycemia

low BUN



Secondary Adrenal Insufficiency: Causes - ✅✅Pituitary lesions/tumors and Metastatic Ca ( breast,
prostate, lung)

Post pituitary resection

Long-term glucocorticoid treatment with secondary adrenal suppression (if stop suddenly- adrenals take
a while to kick in so get insufficiency)

Pan-hypopituitarism

Autoimmune hypophysitis

Sheehan's syndrome (bleeding in pit during child birth)



exogenous steroids (glucocorticoids) - ✅✅Prolonged use of steroids leads to a negative feedback
involving HPA axis

Excessive exogenous steroids will lead to a negative feedback loop inhibiting the secretion of CRH and
ACTH

If steroids discontinued abruptly after being used for 20 or more days, patient will be adrenally
insufficient

IF ON MORE THAN 15 MG PREDNISONE CHRONICALLY, ADRENALS ARE SUPPRESSED IN VIRTUALLY 100%

Can occur with inhaled/injected/topical steroids as well



Secondary Adrenal Insufficiency - ✅✅Symptoms less pronounced bacuase some (little) amount of
SCTH being released