Adrenal Insufficiency

Symptoms

  • Primary Adrenal Insufficiency (reduction of corticosteroid AND mineralocorticoid levels)
    • Fatigue, anorexia/weight loss, abdominal pain, hypoglycemia, hypotension, hyponatremia, hyperkalemia, hyperpigmentation
  • Secondary Adrenal Insufficiency (reduction primarily of corticosteroid levels)
    • Fatigue, anorexia/weight loss, abdominal pain, hypoglycemia, hypotension

Diagnosis

Etiologies

  • Primary Adrenal Insufficiency
    • Drug-Induced
      • Ketoconazole, mitotane
    • Autoimmune Adrenalitis: Most common cause
      • 21-hydroxylase antibodies are found in approximately 90%
      • On CT, Adrenal glands often appear atrophic, although normal-sized adrenal glands do not rule out this diagnosis
    • Adrenoleukodystrophy
      • Elevated VLCFA (Very Long Chain Fatty Acids)
    • Infiltrative disease (lymphoma, sarcoidosis, histoplasmosis, or tuberculosis):
      • On CT, typically enlarged adrenal glands
    • Bilateral adrenal hemorrhage
      • On CT, typically enlarged adrenal glands
  • Secondary/Tertiary Adrenal Insufficiency
    • Pituitary/Hypothalamic dysfunction (1)
      • Masses
      • Radiation
      • Surgery
      • Infiltrative disease (hemochromatosis, sarcoidosis, amyloidosis)
      • Empty sella syndrome
        • Occurs when CSF fills the sella turcica, compressing the pituitary gland. May occur through a defect in the sellar diaphragm or d/t injury to the pituitary gland (from surgery/radiation)
      • Infarction (Sheehan Syndrome)
        • D/t excessive blood loss during childbirth
      • Apoplexy
        • Spontaneous hemorrhage into the pituitary gland (usually from a pituitary adenoma)
      • Genetic mutations

References

  1. Hurd, R., Karlin, R., & Foley, M. (n.d.). Hypopituitarism. Cedars Sinai. Retrieved December 19, 2021, from https://www.cedars-sinai.org/health-library/diseases-and-conditions/h/hypopituitarism.html 

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