Adrenal Insufficiency: A Case Study

Adrenal insufficiency is a disorder of the adrenal glands, where the glands fail to produce adequate mineralocorticoids, glucocorticoids, and adrenal androgens. The most common cause of primary adrenal insufficiency in developed countries is autoimmune; however, medications, infectious diseases, and trauma can also induce adrenal insufficiency. Exogenous steroid use is also a common cause of secondary adrenal insufficiency. Symptoms are related to alterations in the salt and water balance in the body and develop slowly over several months. Patients usually develop fatigue, nausea, vomiting, abdominal pain, myalgias, weight loss, and salt craving. Hyponatremia and hyperkalemia are common. Most patients eventually develop hyperpigmented skin and mucus membranes without treatment. Acute adrenal crisis is a medical emergency characterized by hypotension, lethargy, tachycardia, nausea and vomiting, and hypoglycemia. This requires prompt treatment with intravenous fluids, blood pressure support, and stress dosing of intravenous hydrocortisone. Patients who are correctly identified and treated can make a full recovery, although they will require lifelong replacement of mineralocorticoids and glucocorticoids. Patients who have stabilized their replacement regimens will also require increased doses during periods of illness or stress, such as viral infections or surgery. Emergency clinicians should be aware of the signs and symptoms of adrenal insufficiency and be ready to intervene to prevent life threatening complications.