Adrenocortical Insufficiency

Adrenocortical insufficiency is deficient cortisol (and often aldosterone) production. Classification: primary (adrenal gland destruction - autoimmune Addison, TB, hemorrhage, CAH), secondary (pituitary ACTH deficiency), tertiary (hypothalamic CRH deficiency, often after chronic steroid withdrawal). Primary features hyperpigmentation, hyperkalemia, volume depletion; secondary/tertiary lack hyperpigmentation and aldosterone is usually preserved. Clinical: fatigue, weight loss, hypotension, nausea, salt craving. Acute adrenal crisis presents with shock and requires IV hydrocortisone and fluids.

Common Symptoms

Fatigue; weight loss; hypotension; anorexia; nausea; hyperpigmentation (primary); salt craving; hypoglycemia

Causes and Pathogenesis

Primary: adrenal destruction. Secondary/tertiary: ACTH/CRH deficiency (often from exogenous steroid withdrawal). Loss of cortisol impairs vascular tone, glucose homeostasis, and stress response.

Treatment

Hydrocortisone glucocorticoid replacement; fludrocortisone in primary; stress-dose during illness/surgery; adrenal crisis: IV saline + hydrocortisone

Preventive Measures

Avoid abrupt steroid withdrawal; medical-alert bracelet; sick-day rules; 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.