Adrenal Insufficiency: Investigation and Management

Understanding Adrenal Insufficiency

Adrenal insufficiency, although relatively uncommon, can lead to serious complications if left untreated. The condition is categorized into primary, secondary, and glucocorticoid-induced types. Primary adrenal insufficiency occurs when the adrenal glands are incapable of producing cortisol, often due to autoimmune adrenalitis, infectious causes, congenital adrenal hyperplasia, or adrenal gland removal. Secondary adrenal insufficiency, on the other hand, results from a dysfunction in the pituitary gland, which fails to stimulate the adrenal glands to produce cortisol. Glucocorticoid-induced adrenal insufficiency is the most common type and is caused by exogenous glucocorticoid use, leading to adrenal gland atrophy. Symptoms of adrenal insufficiency can be nonspecific, such as fatigue, weakness, and mood changes, similar to other conditions like depression or chronic fatigue syndrome. Misdiagnosis is common, and delayed diagnosis may result in adrenal crisis, a life-threatening condition. Physical findings can differ depending on the type of adrenal insufficiency, such as weight loss in primary adrenal insufficiency. Testing cortisol, ACTH, and DHEA levels can help confirm the diagnosis. Management involves cortisol replacement, with hydrocortisone or prednisone being common options. Aldosterone replacement may be necessary for primary adrenal insufficiency, and DHEA supplementation can be considered in women based on patient preference and quality of life. For patients on exogenous glucocorticoids, tapering their dosage is necessary, and the duration and speed of tapering should be individualized based on the dose and duration of use. Close follow-up with an endocrinologist is recommended for primary and secondary adrenal insufficiency cases.