Adrenal Insufficiency (Secondary)

Etiology

  • Problem at level of pituitary/hypothalamus → low ACTH
  • Meds→ chronic glucocorticoids (most common), surgery, tumor, hypo-perfusion (Sheehan's: post-partum bleeding→ shock), infiltrative (e.g. Sarcoid), infection, XRT, trauma

Symptoms

  • Fever
  • Salt craving
  • Sub-acute feeling poorly in general, n, v, weakness
  • Weight loss, muscle aches
  • Headaches and bitemporal visual field cuts if related to pituitary mass/bleeding
  • Orthostatic sx/dizziness
  • Decreased libido in women
  • If receiving chronic steroids, symptoms may occur if stopped to quickly and/or superimposed acute illness
  • May have symptoms related to decreased production of other hormones: e.g. low TSH (and T4), low LH (and testosterone)

Physical Exam Findings

  • Hypotension: frankly low BP and/or orthostatic
  • Loss of axillary & pubic hair in women
  • Primary AI: Sometimes darkening of mucous membranes, skin folds, & pressure points
  • Can appear cushingoid if on chronic glucocorticoids (e.g. prednisone)

Tests