Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fatigue
- anorexia
- weight loss
- hyperpigmentation
- salt craving
Risk factors
- female sex
- adrenocortical autoantibodies
- adrenal haemorrhage
- autoimmune diseases
- tuberculosis (TB)
- non-TB bacterial infection
- fungal infection
- HIV
- drugs that inhibit cortisol production
- metastatic malignancy
- coeliac disease
- sarcoidosis
Diagnostic investigations
Investigations to consider
- adrenocorticotrophic hormone (ACTH) stimulation test
- serum ACTH
- plasma renin activity
- plasma aldosterone
- plasma dehydroepiandrosterone (DHEA)
- plasma DHEA sulphate (DHEAS)
- adrenal antibodies
- adrenal CT or MRI
- insulin hypoglycaemia test
- overnight single-dose metyrapone test
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 topic.
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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