Adrenal Insufficiency in Adults: A Review

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Adrenal insufficiency, a cortisol deficiency syndrome, presents as primary, secondary, or glucocorticoid-induced.
• While primary and secondary forms are rare, glucocorticoid-induced adrenal insufficiency is prevalent.

Purpose of the Study:

• To outline the causes, presentation, diagnosis, and management of adrenal insufficiency.
• To emphasize the commonality of glucocorticoid-induced adrenal insufficiency and its distinction from rarer forms.

Main Methods:

• Review of causes including autoimmune, congenital, pharmacological, infectious, and surgical factors for primary and secondary adrenal insufficiency.
• Description of diagnostic methods: early-morning serum cortisol, corticotropin, and dehydroepiandrosterone sulfate (DHEAS) measurements, with corticotropin stimulation testing for ambiguous cases.
• Outline of treatment strategies: glucocorticoid supplementation, mineralocorticoid addition for primary cases, and patient education on managing acute illness and adrenal crisis.

Main Results:

• Nonspecific symptoms like fatigue, nausea, vomiting, anorexia, and weight loss are common in patients with adrenal insufficiency.
• Diagnostic criteria differentiate primary (low cortisol, high corticotropin, low DHEAS) from secondary/glucocorticoid-induced (low/intermediate cortisol, low/low-normal corticotropin and DHEAS).
• Adrenal crisis is a life-threatening complication requiring prompt recognition and management with injectable glucocorticoids.

Conclusions:

• Glucocorticoid-induced adrenal insufficiency is a common condition requiring clinical suspicion, especially after glucocorticoid withdrawal.
• Accurate diagnosis relies on specific hormonal measurements, differentiating between the types of adrenal insufficiency.
• Comprehensive management includes glucocorticoid replacement, mineralocorticoids when necessary, and crucial patient education for preventing adrenal crisis.