Adrenocortical insufficiency

Causes

Appropriate 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 Ab, Thyroid Ab, Ovarian Ab.

Isolated adrenalitis

 

Polyglandular autoimmune candidiasis, including

  • Chronic mucocutaneous candidiasis

Adrenal Ab.

Infections, especially

 
  • Tuberculosis
 
  • 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

Fine needle aspiration biopsy, if appropriate, after diagnostic imaging.

Adrenal haemorrhage

 

Secondary

 

Corticosteroid withdrawal

 

Hypopituitarism