Adrenal insufficiency: Clinical sciences

Adrenal insufficiency is an uncommon, but potentially life-threatening condition, that occurs when hormones from the adrenal gland, like glucocorticoids and mineralocorticoids, are insufficient to meet the body’s demands. Common causes of adrenal insufficiency include autoimmunity, infections, malignancy, or exogenous use of glucocorticoids. And based on the location of the underlying cause, adrenal insufficiency can be classified as primary, which is when the adrenal gland cannot produce hormones; secondary, or when there are abnormalities in the hypothalamic-pituitary-adrenal axis or HPA axis for short; and tertiary, which is often due to exogenous glucocorticoid steroid use.

Now, if you suspect adrenal insufficiency, first, you should perform an ABCDE assessment to determine if the patient is unstable or stable.

If unstable, stabilize their airway, breathing, and circulation. Additionally, obtain IV access, provide supplemental oxygen, if needed, and put them on continuous vital sign monitoring, including blood pressure, heart rate, and pulse oximetry.

Next, proceed with a focused history and physical examination, and obtain labs like a CMP and calcium level.

Typically, your patient will report fatigue, nausea and vomiting, as well as headaches, muscle pain, and cramping. Additionally, they will likely have a history of some sort of exacerbated stress on the body. This could come from a recent bout of gastroenteritis or food poisoning, a recent medical procedure, or being under significant psychological stress.

On the other hand, physical exam findings usually include an acutely ill-appearing individual with hypotension or even shock, as well as altered mental status, and significant abdominal tenderness.

Finally, labs can reveal hypoglycemia, as well as different types of electrolyte abnormalities, including hyponatremia, hyperkalemia, and hypercalcemia. Additionally, you might notice elevated creatinine from significant dehydration.