Adrenocortical insufficiency

Adrenocortical insufficiency

Adrenocortical insufficiency	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 syndrome incl Chronic mucocutaneous candidiasis	Adrenal antibodies .
Infections eg
Tuberculosis
Septicaemia esp Meningococcal septicaemia
HIV infection esp	See also AIDS .
Cytomegalovirus infection
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