- Primary AI: Problem at level of adrenal gland, including: autoimmune destruction → assoc w/dm 1, celiac dz; Hemorrhage/infarct; infection → TB, HIV; infiltration w/tumor; meds (e.g. Ketoconazole)
- Secondary AI: Problem at level of pituitary/hypothalamus → low ACTH; Meds→ chronic glucocorticoids (most common), immnue modulator induced hypophysitis (e.g. Ipilimumab); surgery; tumor; hypo-perfusion (Sheehan's: post-partum bleeding→ shock); infiltrative (e.g. Sarcoid); infection; XRT; trauma
- Sub-acute feeling poorly in general, n, v, weakness
- Weight loss, muscle aches
- Orthostatic sx/dizziness
- Decreased libido in women
- If receiving chronic steroids, symptoms may occur when stopped to quickly and/or superimposed acute illness
- 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
- Secondary AI: can appear cushingoid if on chronic glucocorticoids (e.g. prednisone)
- Low AM cortisol
- If primary AI, ACTH simultaneously high
- Sometimes hyponatremia, hyperkalemia, low glucose, eosinophilia