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
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
