RT Journal Article
SR Electronic
T1 Diagnosis and management of adrenal insufficiency
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 115
OP 118
DO 10.7861/clinmed.2023-0067
VO 23
IS 2
A1 Alexander Lewis
A1 Aye Aye Thant
A1 Aisha Aslam
A1 Pyei Phyoe Myint Aung
A1 Shazli Azmi
YR 2023
UL http://www.rcpjournals.org/content/23/2/115.abstract
AB Adrenal insufficiency is the inadequate secretion of glucocorticoid and/or mineralocorticoid secretion from the adrenal cortex. Primary adrenal insufficiency is the result of failure of the adrenal gland and secondary adrenal insufficiency is due to a lack of stimulation via pituitary adrenocorticotropic hormone or hypothalamic corticotropin-releasing hormone. Adrenal insufficiency may cause non-specific symptoms. Early detection and testing based on clinical suspicion may prevent subsequent presentation with adrenal crisis. Once identified, a low baseline cortisol (often <100 nmol/L) alongside raised adrenocorticotropic hormone (ACTH) can be enough to diagnose primary adrenal insufficiency. However, confirmatory testing can be done using the cosyntopin (Synacthen®) stimulation test or the insulin tolerance test, which is the gold standard for secondary adrenal insufficiency. The underlying cause of adrenal insufficiency can often be identified via a strategic approach to investigation. Adrenal crisis is a life-threatening medical emergency which must be treated immediately if there is strong clinical suspicion with fluids and corticosteroids otherwise can be fatal. Patients must be educated and empowered to take control of their own medical management.