Adrenal Insufficiency

Adrenal insufficiency is a rare condition that occurs most commonly as a result of chronic treatment with glucocorticoids. Rapid discontinuation of chronic glucocorticoid treatment, as well as stressors such as infection or surgery, can precipitate acute adrenal insufficiency. Primary adrenal insufficiency (Addison's disease) and secondary adrenal insufficiency (failure of the hypothalamic-pituitary axis leading to decreased ACTH) is infrequently diagnosed in the ED. Patients who are receiving ongoing steroid treatment and who are acutely ill (often hypovolemic and hypotensive, and possibly hypoglycemic) are generally treated with "stress-dose steroids" because of adrenal suppression caused by the exogenous glucocorticoids. This therapy is in addition to therapy designed to address a primary medical or surgical condition that is often present.

Causes

The possible causes of Adrenal insufficiency are included in the list below:

• Isolated corticotropin deficiency
• Surgery
• Anesthesia
• Asthma
• Hypothermia
• Myocardial infarction
• Fever
• Hypoglycemia
• Cancer cells spreading from other parts of the body to the adrenal glands

Symptoms

• Symptoms of primary illness when secondary to physiologic stressor
• Weakness +++++
• Fatigue +++++
• Anorexia +++++
• Weight loss +++++ (when chronic)
• Nausea and vomiting +++
• Abdominal pain +++
• Diarrhea or constipation ++

Signs

• Lethargy
• Hypotension ++++
• Hyperpigmentation +++++ (when chronic)

Treatment

If adrenal insufficiency is untreated, serious illness. Synthetic glucocorticoids that replace the deficient adrenal steroid hormones are the main treatment. They taken daily and as directed to keep the body in balance. Synthetic mineralocorticoid and androgen medications may also be necessary. If you have adrenal insufficiency and under physical stress, you may need to take glucocorticoids to counter the excess stress on your body. Discuss with your doctor the need for adequate glucocorticoid replacement if you are having surgery, major dental work or if you are sick with a fever, vomiting etc.