JAMA Clinical Reviews Adrenal Insufficiency in Adults
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Jun 16, 2025 Anand Vaidya, an Associate Professor of Medicine at Brigham and Women's Hospital and Director of the Center for Adrenal Disorders, dives deep into adrenal insufficiency. He discusses the crucial role of cortisol in metabolic function and stress management. Vaidya outlines the symptoms and mechanisms of this condition, highlighting the importance of timely diagnosis through hormone testing. The treatment strategies, especially glucocorticoid therapy, are explored, including how to manage crisis situations effectively with immediate interventions.
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Cortisol's Role in Stress Response
- Cortisol acts primarily through catabolic processes to mobilize glucose, fats, and proteins as fuel under stress.
- It prevents hypoglycemia and helps regulate blood pressure during systemic stress like illness or pain.
Key Symptoms of Adrenal Insufficiency
- Symptoms of adrenal insufficiency are broad but some signs like hyponatremia and unexplained hyperkalemia are more specific.
- Hyperpigmentation and salt cravings can strongly suggest primary adrenal insufficiency progress.
ACTH Causes Hyperpigmentation
- High ACTH causes hyperpigmentation because it stimulates melanocytes similarly to melanocyte-stimulating hormone.
- This leads to diffuse skin darkening, even in non-sun-exposed areas, especially in primary adrenal insufficiency.