Adrenal insufficiency: Year of the Zebra

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Adrenal insufficiency is an endocrine disorder that occurs when the adrenal glands don’t produce enough of one or more of the hormones, aldosterone, cortisol, and testosterone.
Normally, the adrenal glands are stimulated to produce these hormones by adrenocorticotropic hormone, or ACTH, a hormone produced by the pituitary gland, a small gland at the base of the brain.Now, adrenal insufficiency can be primary or secondary.
In primary adrenal insufficiency, there is plenty of ACTH to stimulate the adrenal glands, but there’s an underlying problem with the adrenal glands themselves, like when the immune system attacks them.
In secondary adrenal insufficiency, there isn’t enough ACTH to stimulate the adrenal glands because of a problem with the pituitary gland, like a tumor.Okay, now, the clinical manifestations of adrenal insufficiency can vary based on the cause.
Nonspecific symptoms include fatigue, nausea, weight loss, and dizziness, as well as loss of libido, or sexual drive, and amenorrhea, or lack of menses.Some individuals may present in adrenal crisis, which is a medical emergency due to severe depletion of cortisol that leads to extremely low blood pressure, weakness, abdominal pain, and changes in mental status, like disorientation.Diagnosis of adrenal insufficiency starts with a history and physical examination.
Imaging tests, like a CT scan or MRI, which can help visualize the adrenal glands or pituitary gland to identify structural abnormalities.
Laboratory tests may also be done and include hormone levels and antibodies against the adrenal glands.Diagnosis can be confirmed with an ACTH stimulation test, which measures levels of cortisol before and after administration of a synthetic hormone.Treatment of primary adrenal insufficiency typically involves hormone replacement therapy.
The type of hormone replacement depends on which hormones are deficient. Treatment can include a mineralocorticoid, like fludrocortisone; a glucocorticoid, like hydrocortisone; or an androgen, like dehydroepiandrosterone, or DHEA.Secondary adrenal insufficiency involves treating the underlying cause, which may include surgery to remove a pituitary tumor.Treatment of adrenal crisis involves intravenous steroids and supportive treatment.Alright, as a quick recap…Adrenal insufficiency is an endocrine disorder that occurs when the adrenal glands don’t produce enough hormones.
Clinical manifestations can include fatigue, weight loss, and loss of libido, or signs and symptoms of shock. Diagnosis is based on history, physical examination, imaging tests, and is confirmed using an ACTH stimulation test.
Treatment involves addressing the underlying cause and hormone replacement therapy.