Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • fatigue
  • anorexia
  • salt craving
  • weight loss
  • hyperpigmentation

Other diagnostic factors

  • nausea
  • vomiting
  • hypotension
  • arthralgia and myalgia

Risk factors

  • female gender
  • adrenocortical autoantibodies
  • adrenal hemorrhage
  • autoimmune diseases
  • tuberculosis (TB)
  • non-TB bacterial infection
  • fungal infection
  • HIV
  • drugs that inhibit cortisol production
  • metastatic malignancy
  • celiac disease
  • sarcoidosis

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • BUN
  • CBC
  • morning serum cortisol
Full details

Investigations to consider

  • ACTH stimulation test
  • serum ACTH
  • plasma renin activity
  • plasma aldosterone
  • plasma dehydroepiandrosterone (DHEA)
  • plasma DHEA sulfate (DHEAS)
  • adrenal antibodies
  • adrenal CT or MRI
  • insulin hypoglycemia test
  • overnight single-dose metyrapone test
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor Emeritus and Honorary Consultant

Department of Endocrinology and Diabetes Mellitus

St. Vincent’s University Hospital

Dublin

Ireland

Disclosures

TJMcK declares that he has no competing interests.

Dr T. Joseph McKenna would like to gratefully acknowledge Dr Shehzad Basaria and Dr Milena Braga-Basaria, previous contributors to this monograph. SB and MBB declare that they have no competing interests.

Peer reviewers VIEW ALL

Division of Endocrinology

Case Medical Center

Cleveland

OH

Disclosures

BA declares that he has no competing interests.

Instructor in Medicine

Brigham and Women's Hospital

Division of Endocrinology

Diabetes and Hypertension

Boston

MA

Disclosures

RKG declares that he has no competing interests.

Head

Department of Endocrinology

Centre Hospitalier Universitaire de Bordeaux

Pessac

France

Disclosures

AT declares that he has no competing interests.

Department of Endocrinology

Centre Hospitalier Universitaire de Bordeaux

Pessac

France

Disclosures

BGC declares that she has no competing interests.

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