Adrenal Insufficiency

Your Path

  • Adrenal Insufficiency


  • 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


  • Fever
  • Salt craving
  • 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

Physical Exam Findings

  • Fever
  • 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)