Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fatigue
- anorexia
- weight loss
- hyperpigmentation
- acute circulatory collapse with hypotension and tachycardia
- salt craving
Other diagnostic factors
- gastrointestinal symptoms (nausea, vomiting, abdominal pain)
- postural hypotension
- arthralgia and myalgia
- axillary and pubic hair loss in women
Risk factors
- female sex
- adrenocortical autoantibodies
- adrenal haemorrhage
- autoimmune diseases
- coeliac disease
- tuberculosis (TB)
- non-TB bacterial infection
- fungal infection
- HIV
- drugs that inhibit cortisol production
- metastatic malignancy
- sarcoidosis
Diagnostic investigations
1st investigations to order
- morning serum cortisol
- plasma adrenocorticotrophic hormone (ACTH)
- serum electrolytes
- urea and creatinine
- FBC
Investigations to consider
- adrenocorticotrophic hormone (ACTH) stimulation test
- plasma renin activity
- serum aldosterone
- serum dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S)
- adrenal antibodies
- adrenal CT or MRI
- insulin hypoglycaemia test
- overnight single-dose metyrapone test
Treatment algorithm
adrenal crisis
minor intercurrent stress
severe intercurrent stress
stable and/or after treatment of acute episode
Contributors
Authors
Laleh Razavi Nematollahi, MD
Assistant Professor of Medicine
Division of Clinical and Molecular Endocrinology and Metabolism
University Hospitals Cleveland Medical Center
Case Western Reserve University
Cleveland
OH
Declarações
LRN declares that she has no competing interests.
Baha Arafah, MD
Chief, Division of Endocrinology
University Hospitals Cleveland Medical Center
Case Western Reserve University
Cleveland
OH
Declarações
BA declares that he has no competing interests.
Agradecimentos
Dr Laleh Razavi Nematollahi and Dr Baha Arafah would like to gratefully acknowledge Dr T. Joseph McKenna, Dr Shehzad Basaria, and Dr Milena Braga-Basaria, previous contributors to this topic.
Declarações
TJM, SB, and MBB declare that they have no competing interests.
Revisores
Rajesh K. Garg, MD
Instructor in Medicine
Brigham and Women's Hospital
Division of Endocrinology
Diabetes and Hypertension
Boston
MA
Declarações
RKG declares that he has no competing interests.
Antoine Tabarin, MD
Head
Department of Endocrinology
Centre Hospitalier Universitaire de Bordeaux
Pessac
France
Declarações
AT declares that he has no competing interests.
Blandine Gatta-Cherifi, MD
Department of Endocrinology
Centre Hospitalier Universitaire de Bordeaux
Pessac
France
Declarações
BGC declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
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):364-89.Texto completo Resumo
Husebye ES, Pearce SH, Krone NP, et al. Adrenal insufficiency. Lancet. 2021 Feb 13;397(10274):613-29. Resumo
Betterle C, Presotto F, Furmaniak J. Epidemiology, pathogenesis, and diagnosis of Addison's disease in adults. J Endocrinol Invest. 2019 Dec;42(12):1407-33. Resumo
Arlt W; Society for Endocrinology Clinical Committee. Society For Endocrinology endocrine emergency guidance: emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients. Endocr Connect. 2016 Sep;5(5):G1-3.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Adrenal suppression due to the use of glucocorticoid or other drugs with glucocorticoid activity (e.g., medroxyprogesterone acetate therapy)
- Central (secondary or tertiary) adrenal insufficiency (pituitary or hypothalamic lesions)
- Haemochromatosis
Mais Diagnósticos diferenciaisGuidelines
- Guidelines for the management and prevention of acute adrenal insufficiency
- Adrenal insufficiency - emergency management practice guideline
Mais GuidelinesPatient information
Primary adrenal insufficiency (Addison's disease): what is it?
Primary adrenal insufficiency (Addison's disease): what are the treatment options?
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