Adrenal insufficiency ( Hypoadrenalism )

Acute or chronic -acute onset - Adrenal crisis ( life threatening ) chronic - can be more difficult to diagnose as presentation can be non-specific and vague hyperpigmentation may not always be present exogenous administration of glucocorticoids is the most common cause of adrenal insufficiency in clinical practice during critical illnesses - functional or relative adrenal insufficiency can be seen

Evaluation - presentation can be with hypotension , altered mental status , anorexia , vomiting , weight loss , fatigue , recurrent abdominal pain in women 0 amenorrhoea , loss of libido , ↓ axillary / pubic hair poor skin turgor , ↑ skin pigmentation consider checking serum cortisol , ACTH , renin , aldosterone and Us&Es ↓ Na , ↑ K , ↓ bl glucose may be present Short ACTH stimulation test should be considered

Level of defect –

Primary- Pathology affects the adrenal gland itself diminished gland function acute presentation can be with adrenal crisis and chronic with Addison's disease most common cause of adrenal insufficiency / Addison's disease is autoimmune destruction of the adrenal cortex other causes include haemorrhage , cancer , infections ( as HIV , syphilis , tuberculosis ) and drugs as ketoconazole , fluconazole...