adrenal%20insufficiency
ADRENAL INSUFFICIENCY
Adrenal insufficiency (AI) is the insufficient secretions of corticosteroids that may cause partial or complete destruction of the adrenal glands.
Primary AI or Addison’s disease is due to the inability of the adrenal gland to produce steroid hormones even when the stimulus by the pituitary gland via corticotrophin is adequate or increased.
Secondary AI is due to disorders of the pituitary gland that causes production of low levels of adrenocorticotropic hormone that will result to reduced cortisol levels.
Tertiary AI is the inability of the hypothalamus to produce sufficient amount of corticotropin releasing hormone.
Signs and symptoms are usually nonspecific with insidious onset.
Common signs and symptoms are fatigue, weakness, salt craving, orthostatic hypotension, nausea, vomiting, abdominal pain, diarrhea, anorexia and weight loss.

Adrenal Insufficiency References

  1. Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA. 2002 Jan;287(2):235-240. PMID: 11779267
  2. Ten S, New M, Maclaren N. Clinical review 130: Addison's disease 2001. J Clin Endocrinol Metab. 2001 Jul;86(7):2909-2922. PMID: 11443143
  3. Oelkers W. Adrenal Insufficiency. N Engl J Med. 1996 Oct;335(16):1206-1212. PMID: 8815944
  4. Zaloga GP, Marik P. Hypothalamic-pituitary-adrenal insufficiency. Crit Care Clin. 2001 Jan;17(1):25-41. PMID: 11219233
  5. Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper, et al, eds. Disorders of the adrenal cortex. Harrison's Online: McGraw-Hill Companies; 2003. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4
  6. Kasper DL, Braunwald E, Fauci AS, et al. Disorders of the Adrenal Cortex. In: Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill; 2005
  7. Thorner MO, Besser GM. Addison's Disease. Comprehensive clinical endocrinology. 3rd ed. London: Mosby; 2002
  8. MedWormhttp://www.medworm.com/rss/index.php/Endocrinology/15/http://www.medworm.com/rss/medicalfeeds/specialities/Endocrinology.xml
  9. Klauer K. Adrenal insufficiency and adrenal crisis. eMedicine. http://emedicine.com/emerg/topic16.htm. 18 Apr 2005
  10. Nieman LK. Clinical manifestations of adrenal insufficiency. UpToDate. http://www.uptodate.com/contents/clinical-manifestations-of-adrenal-insufficiency-in-adults?detectedLanguage=en&source=search_result&search=Clinical+manifestations+of+adrenal+insufficiency&selectedTitle=1~150&provider=noProvider. 01 Aug 2005
  11. Nieman LK. Treatment of adrenal insufficiency in adults. UpToDate. http://www.uptodate.com. Jun 2019.
  12. Weiss MD. Endocrine testing protocols: hypothalamic pituitary adrenal axis. http://www.endotext.org/protocols/protocols1/protocols1.htm. 18 Sep 2002
  13. MedWorm - Adrenal Insufficiencyhttp://www.medworm.com/rss/medicalfeeds/conditions/Adrenal-Insufficiency-News.xml
  14. Gerlach H. Adrenal Insufficiency. In: Vincent JL, Abraham E, Moore F, et al. eds. Textbook of critical care. 6th ed: Elsevier; 2011:1215-1224.
  15. Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 Feb;101(2):364-389. 10.1210/jc.2015-1710. PMID: 26760044
  16. Page S. Management guidelines for adrenal crisis in adults. NHS UK. https://www.nuh.nhs.uk/handlers/downloads.ashx?id=63184. 2016 Jan.
  17. Arlt W, the Society for Endocrinology Clinical Committee. Society for Endocrinology Endocrine Emergency Guidance: Emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients. Endocrine Connections. 2016 Aug;5(5):G1-G3. doi: 10.1530/EC-16-0054. Accessed 31 Jan 2018
  18. Barthel A, Willenberg H S, Gruber M, et al. Adrenal Insufficiency. In: Larry J, De Groot L J, de Kretser D M, eds. Endocrinology: Adult and Pediatric. 7th. Philadelphia, PA: Elsevier, Inc; 2016. http://dx.doi.org/10.1016/B978-0-323-18907-1.00102-5. Accessed 01 Feb 2018:1763-1774.
  19. Jack J, Young S B. Endocrinology. In: The Johns Hopkins Hospital, Hughes H K, Kahl L K. Harriet Lane Handbook. 21st . Philadelphia, PA: Elsevier, Inc; 2018. 255-289. :255-289.
  20. Furst DE, Saag KG. Glucocorticoid withdrawal. UpToDate. https://www.uptodate.com. Jul 2017. Accessed 15 Jul 2019.
  21. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013 Aug;9(1):30. doi: 10.1186/1710-1492-9-30. Accessed 11 Jul 2019. PMID: 23947590
  22. Allolio B. Extensive expertise in endocrinology. Adrenal crisis. Eur J Endocrinol. 2015 Mar;172(3):R115-R124. doi: 10.1530/EJE-14-0824. PMID: 25288693
  23. Bancos I, Hahner S, Tomlinson J, et al. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015 Mar;3(3):216-226. doi: 10.1016/S2213-8587(14)70142-1. PMID: 25098712
  24. Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016 Nov;101(11):3888-3921. PMID: 27736313
  25. Husebye ES, Allolio B, Arlt W, et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014 Feb;275(2):104-115. doi: 10.1111/joim.12162. PMID: 24330030
  26. Nieman LK. Diagnosis of adrenal insufficiency in adults. UpToDate. https://www.uptodate.com. Jun 2019.
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