Primary Adrenocortical Insufficiency

Primary adrenocortical insufficiency (Addison disease) is progressive destruction of the adrenal cortex causing cortisol and aldosterone deficiency. Causes: autoimmune adrenalitis (most common in developed countries), TB, HIV, metastatic disease, adrenal hemorrhage, congenital adrenal hyperplasia. Clinical: fatigue, weight loss, hyperpigmentation, orthostatic hypotension, hyponatremia, hyperkalemia, hypoglycemia. Adrenal crisis (acute stress) is life-threatening with hypotension/shock; requires immediate IV hydrocortisone and fluids.

Common Symptoms

Fatigue; weight loss; skin/mucosal hyperpigmentation; orthostatic hypotension; anorexia; salt craving; hyponatremia/hyperkalemia

Causes and Pathogenesis

Autoimmune/infectious/hemorrhagic destruction of adrenal cortex reduces cortisol and aldosterone; ACTH rises (MSH component drives hyperpigmentation).

Treatment

Glucocorticoid (hydrocortisone) and mineralocorticoid (fludrocortisone) replacement; stress-dose steroids during illness/surgery; adrenal crisis: IV saline + hydrocortisone

Preventive Measures

Wear medical alert; stress-dose education; ensure adequate salt; regular endocrine follow-up.

Department to Visit

It is recommended to visit the Endocrinology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.