When to suspect adrenal insufficiency: Adrenal insufficiency: identification and management
- PMID: 39541489
- Bookshelf ID: NBK609103
When to suspect adrenal insufficiency: Adrenal insufficiency: identification and management
Excerpt
Whilst adrenal insufficiency is rare, not diagnosing it has fatal consequences, indeed some patients present with adrenal crisis, hence healthcare professionals should be aware of the risks factors and signs and symptoms associated with this condition.
Primary adrenal Insufficiency: Addis
on’s disease is the most common cause in adults, and congenital adrenal hyperplasia is the most common cause in children.
Secondary adrenal insufficiency: caused by inadequate adrenocorticotropic hormone production by the pituitary gland, often because of treatment for pituitary disease, or from pituitary tumours and their treatment)
Tertiary adrenal insufficiency: caused by inadequate corticotrophin-releasing hormone production by the hypothalamus. This can be because of treatment for tumours in the hypothalamus or adjoining structures, or more commonly because of administration of glucocorticoids for more than 4 weeks causing hypothalamic-pituitary-adrenal axis [HPA-axis] suppression). Stopping glucocorticoids abruptly may also cause adrenal insufficiency.
Some medicines may cause adrenal insufficiency, such as opioids, checkpoint inhibitors (used increasingly for treating cancer), and medicines inhibiting cortisol clearance such as antifungals and antiretrovirals.
There are number of signs and symptoms for AI and factors that can cause AI (risk factors); however, their ability to discriminate AI accurately enough to make a differential diagnosis and begin treatment is uncertain. The aim of this review is to determine whether these signs, symptoms and risk factors can be as prompts for health care professionals to consider a diagnosis of adrenal insufficiency to initiate treatment in a timely way to prevent death or significant morbidity.
Copyright © NICE 2024.
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