Adrenocortical insufficiency

Last updated: Monday, 25, October, 2010
CausesAppropriate Tests

Addisonian crisis (hypotension, hypovolaemia, hyperkalaemia; usually with hyponatraemia and hypoglycaemia) is a medical emergency and treatment should not be delayed pending hormone assay results.

Blood should be collected prior to treatment, for subsequent assay of cortisol and ACTH, to confirm or exclude the clinical diagnosis of adrenocortical insufficiency.

Synacthen stimulation test is the definitive test and may be required subsequently, if the initial test results are not diagnostic.

Primary (Addison’s disease)

Autoimmune

Adrenal antibodies, thyroid antibodies, ovarian antibodies.

Isolated adrenalitis

Polyglandular autoimmune candidiasis, including

  • Chronic mucocutaneous candidiasis

Adrenal antibodies.

Infections, especially

  • Septicaemia, especially
    • Meningococcal septicaemia
  • HIV infection, especially
    • Cytomegalovirus infection

See also AIDS.

Genetic

Congenital adrenal hyperplasia

17-Hydroxyprogesterone; renin for monitoring mineralocorticoid replacement therapy.

Adrenoleukodystrophy

Very long chain fatty acids.

Adrenal hypoplasia (X linked)

Metastatic carcinoma

FNAB, if appropriate, after diagnostic imaging.

Adrenal haemorrhage

Secondary

Corticosteroid withdrawal

Hypopituitarism