Primary adrenal insufficiency - Revision history

Aidan at 17:28, 3 March 2026

2026-03-03T17:28:50Z

← Older revision		Revision as of 17:28, 3 March 2026
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	*A single baseline ACTH and cortisol, ideally morning		*A single baseline ACTH and cortisol, ideally morning
	**Cortisol is 80% bound to CBG (increased by estrogen, pregnancy, mitotane) and 10-15% bound to albumin		**Cortisol is 80% bound to CBG (increased by estrogen, pregnancy, mitotane) and 10-15% bound to albumin
			**Low cortisol with elevated ACTH suggests primary adrenal insufficiency, whereas low cortisol with low ACTH suggests secondary or tertiary adrenal insufficiency
	*Corticotropin stimulation test		*Corticotropin stimulation test
	**Get ACTH (will tell you if ACTH-dependent or -independent), baseline cortisol, +/- aldosterone		**Get ACTH (will tell you if ACTH-dependent or -independent), baseline cortisol, +/- aldosterone

Aidan at 16:12, 5 February 2026

2026-02-05T16:12:49Z

← Older revision		Revision as of 16:12, 5 February 2026
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	*Acute adrenal insufficiency typically occurs in patients with known preexisting chronic adrenal insufficiency who develop an intercurrent illness		*Acute adrenal insufficiency typically occurs in patients with known preexisting chronic adrenal insufficiency who develop an intercurrent illness
	**Sometimes can occur without a prior history of adrenal insufficiency, such as tuberculous adrenalitis or Waterhouse-Friderichsen syndrome from meningococcemia		**Sometimes can occur without a prior history of adrenal insufficiency, such as tuberculous adrenalitis or [[Waterhouse-Friderichsen syndrome]] from meningococcemia
	*Severe weakness, syncope, abdominal pain, nausea, vomiting, back pain, confusion		*Severe weakness, syncope, abdominal pain, nausea, vomiting, back pain, confusion
	*Hypotension, abdominal tenderness or guarding, altered consciousness, delirium		*Hypotension, abdominal tenderness or guarding, altered consciousness, delirium

Aidan: /* Adrenal Crisis */

2026-02-05T16:12:15Z

Adrenal Crisis

← Older revision		Revision as of 16:12, 5 February 2026
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	===Adrenal Crisis===		===Adrenal Crisis===

			*Acute adrenal insufficiency typically occurs in patients with known preexisting chronic adrenal insufficiency who develop an intercurrent illness
			**Sometimes can occur without a prior history of adrenal insufficiency, such as tuberculous adrenalitis or Waterhouse-Friderichsen syndrome from meningococcemia
	*Severe weakness, syncope, abdominal pain, nausea, vomiting, back pain, confusion		*Severe weakness, syncope, abdominal pain, nausea, vomiting, back pain, confusion
	*Hypotension, abdominal tenderness or guarding, altered consciousness, delirium		*Hypotension, abdominal tenderness or guarding, altered consciousness, delirium

Aidan: /* Etiology */

2025-05-05T17:28:42Z

Etiology

← Older revision		Revision as of 17:28, 5 May 2025
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	*Autoimmune (70-90%)		*Autoimmune (70-90%)
	**Isolated adrenal ~~insuggiciency~~		**Isolated adrenal insufficiency
	**[[Polyglandular autoimmune syndrome type I]] and [[Polyglandular autoimmune syndrome type II\|type II]]		**[[Polyglandular autoimmune syndrome type I]] and [[Polyglandular autoimmune syndrome type II\|type II]]
	*Infection: [[tuberculosis]] (most common in developing world), [[histoplasmosis]], [[paracoccidioidomycosis]], [[HIV]], [[CMV]], [[syphilis]], [[African trypanosomiasis]]		*Infection: [[tuberculosis]] (most common in developing world), [[histoplasmosis]], [[paracoccidioidomycosis]], [[HIV]], [[CMV]], [[syphilis]], [[African trypanosomiasis]]

Aidan: /* Etiology */

2021-03-06T16:01:39Z

Etiology

← Older revision		Revision as of 16:01, 6 March 2021
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	**Bilateral adrenal hemorrhage		**Bilateral adrenal hemorrhage
	**[[Sepsis]], especially with [[Neisseria meningitidis]]		**[[Sepsis]], especially with [[Neisseria meningitidis]]
	**Coagulopathy or [[~~Waterhouse–Friderichsen~~ syndrome]]		**Coagulopathy or [[Waterhouse-Friderichsen syndrome]]
	**Thrombosis, embolism, adrenal infarction		**Thrombosis, embolism, adrenal infarction
	*Drugs		*Drugs

Aidan at 16:00, 6 March 2021

2021-03-06T16:00:25Z

← Older revision		Revision as of 16:00, 6 March 2021
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	== Background ==		==Background==

	=== Etiology ===		===Etiology===

	* Autoimmune (70-90%)		*Autoimmune (70-90%)
	** Isolated adrenal insuggiciency		**Isolated adrenal insuggiciency
	** Polyglandular autoimmune syndrome type I and II		**[[Polyglandular autoimmune syndrome type I]] and [[Polyglandular autoimmune syndrome type II\|type II]]
	* Infection: tuberculosis (most common in developing ~~worls~~), histoplasmosis, ~~paracoccidioidomycocis~~, HIV, CMV, syphilis, African trypanosomiasis		*Infection: [[tuberculosis]] (most common in developing world), [[histoplasmosis]], [[paracoccidioidomycosis]], [[HIV]], [[CMV]], [[syphilis]], [[African trypanosomiasis]]
	* Infiltrative:		*Infiltrative:
	** Metastatic cancer (lung > stomach > esophagus > colon > breast)		**Metastatic cancer (lung > stomach > esophagus > colon > breast)
	** Lymphoma		**[[Lymphoma]]
	** Sarcoidosis, amyloidosis, hemochromatosis		**[[Sarcoidosis]], [[amyloidosis]], [[hemochromatosis]]
	* Vascular		*Vascular
	** Bilateral adrenal hemorrhage		**Bilateral adrenal hemorrhage
	** Sepsis, especially with [[Neisseria meningitidis]]		**[[Sepsis]], especially with [[Neisseria meningitidis]]
	** Coagulopathy or ~~Waterhouse-Friderichsen~~ syndrome		**Coagulopathy or [[Waterhouse–Friderichsen syndrome]]
	** Thrombosis, embolism, adrenal infarction		**Thrombosis, embolism, adrenal infarction
	* Drugs		*Drugs
	** Inhibit cortisol: ketoconazole, etomidate, megesterol acetate		**Inhibit cortisol: [[ketoconazole]], [[etomidate]], [[megesterol acetate]]
	** Increase cortisol metabolism: rifampin, phenytoin, barbiturates		**Increase cortisol metabolism: [[rifampin]], [[phenytoin]], [[barbiturates]]
	* Other		*Other
	** Adrenoleukodystrophy		**[[Adrenoleukodystrophy]]
	** Congenital adrenal hypoplasia		**[[Congenital adrenal hypoplasia]]
	** Familial glucocorticoid deficiency or resistance		**Familial glucocorticoid deficiency or resistance

	=== Risk Factors ===		===Risk Factors===

	* [[Type 1 diabetes mellitus]]		*[[Type 1 diabetes mellitus]]
	* [[Autoimmune gastritis]]		*[[Autoimmune gastritis]]
	* [[Pernicious anemia]]		*[[Pernicious anemia]]
	* [[Vitiligo]]		*[[Vitiligo]]

	== Clinical Manifestations ==		==Clinical Manifestations==

	=== Adrenal Insufficiency ===		===Adrenal Insufficiency===

	* Fatigue, weight loss, postural dizziness, anorexia, abdominal discomfort		*Fatigue, weight loss, postural dizziness, anorexia, abdominal discomfort
	* [[Causes::Hyperpigmentation]] (primary only), particularly of sun-exposed areas, skin creases, mucosal membranes, scars, and areola, low blood pressure with postural drop, failure to thrive (in children)		*[[Causes::Hyperpigmentation]] (primary only), particularly of sun-exposed areas, skin creases, mucosal membranes, scars, and areola, low blood pressure with postural drop, failure to thrive (in children)
	* Labs may show [[Causes::hyponatremia]], [[Causes::hyperkalemia]] and, occasionally, hypoglycemia (especially in children) or hypercalcemia		*Labs may show [[Causes::hyponatremia]], [[Causes::hyperkalemia]] and, occasionally, hypoglycemia (especially in children) or hypercalcemia

	=== Adrenal Crisis ===		===Adrenal Crisis===

	* Severe weakness, syncope, abdominal pain, nausea, vomiting, back pain, confusion		*Severe weakness, syncope, abdominal pain, nausea, vomiting, back pain, confusion
	* Hypotension, abdominal tenderness or guarding, altered consciousness, delirium		*Hypotension, abdominal tenderness or guarding, altered consciousness, delirium
	* [[Causes::Hyponatremia]], [[Causes::hyperkalemia]], hypoglycemia, hypercalcemia		*[[Causes::Hyponatremia]], [[Causes::hyperkalemia]], hypoglycemia, hypercalcemia

	== Differential Diagnosis ==		==Differential Diagnosis==

	* Adrenal suppression with mitotane, ketoconazole, metyrapone, etomidate		*Adrenal suppression with mitotane, ketoconazole, metyrapone, etomidate
	* Increased cortisol metabolism with mitotane, phenytoin, carbamazepine, and St. John's wort		*Increased cortisol metabolism with mitotane, phenytoin, carbamazepine, and St. John's wort

	== Diagnosis ==		==Diagnosis==

	* A single baseline ACTH and cortisol, ideally morning		*A single baseline ACTH and cortisol, ideally morning
	** Cortisol is 80% bound to CBG (increased by estrogen, pregnancy, mitotane) and 10-15% bound to albumin		**Cortisol is 80% bound to CBG (increased by estrogen, pregnancy, mitotane) and 10-15% bound to albumin
	* Corticotropin stimulation test		*Corticotropin stimulation test
	** Get ACTH (will tell you if ACTH-dependent or -independent), baseline cortisol, +/- aldosterone		**Get ACTH (will tell you if ACTH-dependent or -independent), baseline cortisol, +/- aldosterone
	** Give Cosyntropin 0.25 mg IM/IV		**Give Cosyntropin 0.25 mg IM/IV
	** Check cortisol at 30 minutes and 60 minutes		**Check cortisol at 30 minutes and 60 minutes
	** A normal test is if cortisol rises to a peak of 500-550 nmol/L by 60 minutes		**A normal test is if cortisol rises to a peak of 500-550 nmol/L by 60 minutes

	<br />		<br />

Aidan: Created page with "== Background == === Etiology === * Autoimmune (70-90%) Isolated adrenal insuggiciency Polyglandular autoimmune syndrome type I and II * Infection: tuberculosis (most..."

2021-03-04T17:05:41Z

Created page with "== Background == === Etiology === * Autoimmune (70-90%) ** Isolated adrenal insuggiciency ** Polyglandular autoimmune syndrome type I and II * Infection: tuberculosis (most..."

New page

== Background ==

=== Etiology ===

* Autoimmune (70-90%)
** Isolated adrenal insuggiciency
** Polyglandular autoimmune syndrome type I and II
* Infection: tuberculosis (most common in developing worls), histoplasmosis, paracoccidioidomycocis, HIV, CMV, syphilis, African trypanosomiasis
* Infiltrative:
** Metastatic cancer (lung > stomach > esophagus > colon > breast)
** Lymphoma
** Sarcoidosis, amyloidosis, hemochromatosis
* Vascular
** Bilateral adrenal hemorrhage
** Sepsis, especially with [[Neisseria meningitidis]]
** Coagulopathy or Waterhouse-Friderichsen syndrome
** Thrombosis, embolism, adrenal infarction
* Drugs
** Inhibit cortisol: ketoconazole, etomidate, megesterol acetate
** Increase cortisol metabolism: rifampin, phenytoin, barbiturates
* Other
** Adrenoleukodystrophy
** Congenital adrenal hypoplasia
** Familial glucocorticoid deficiency or resistance

=== Risk Factors ===

* [[Type 1 diabetes mellitus]]
* [[Autoimmune gastritis]]
* [[Pernicious anemia]]
* [[Vitiligo]]

== Clinical Manifestations ==

=== Adrenal Insufficiency ===

* Fatigue, weight loss, postural dizziness, anorexia, abdominal discomfort
* [[Causes::Hyperpigmentation]] (primary only), particularly of sun-exposed areas, skin creases, mucosal membranes, scars, and areola, low blood pressure with postural drop, failure to thrive (in children)
* Labs may show [[Causes::hyponatremia]], [[Causes::hyperkalemia]] and, occasionally, hypoglycemia (especially in children) or hypercalcemia

=== Adrenal Crisis ===

* Severe weakness, syncope, abdominal pain, nausea, vomiting, back pain, confusion
* Hypotension, abdominal tenderness or guarding, altered consciousness, delirium
* [[Causes::Hyponatremia]], [[Causes::hyperkalemia]], hypoglycemia, hypercalcemia

== Differential Diagnosis ==

* Adrenal suppression with mitotane, ketoconazole, metyrapone, etomidate
* Increased cortisol metabolism with mitotane, phenytoin, carbamazepine, and St. John's wort

== Diagnosis ==

* A single baseline ACTH and cortisol, ideally morning
** Cortisol is 80% bound to CBG (increased by estrogen, pregnancy, mitotane) and 10-15% bound to albumin
* Corticotropin stimulation test
** Get ACTH (will tell you if ACTH-dependent or -independent), baseline cortisol, +/- aldosterone
** Give Cosyntropin 0.25 mg IM/IV
** Check cortisol at 30 minutes and 60 minutes
** A normal test is if cortisol rises to a peak of 500-550 nmol/L by 60 minutes

<br />
[[Category:Endocrinology]]

Primary adrenal insufficiency - Revision history

Aidan at 17:28, 3 March 2026

Aidan at 16:12, 5 February 2026

Aidan: /* Adrenal Crisis */

Aidan: /* Etiology */

Aidan: /* Etiology */

Aidan at 16:00, 6 March 2021

Aidan: Created page with "== Background == === Etiology === * Autoimmune (70-90%) ** Isolated adrenal insuggiciency ** Polyglandular autoimmune syndrome type I and II * Infection: tuberculosis (most..."

Aidan: Created page with "== Background == === Etiology === * Autoimmune (70-90%) Isolated adrenal insuggiciency Polyglandular autoimmune syndrome type I and II * Infection: tuberculosis (most..."