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

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