Adrenal Insufficiency

Question 1

Define adrenal insufficiency

Answer 1

Deficiency of adrenal cortical hormones (e.g. mineralocorticoids, glucocorticoids and androgens)

Question 2

Explain the aetiology / risk factors of adrenal insufficiency

Answer 2

•	Primary Adrenal Insufficiency
o	Addison's disease (usually autoimmune)
•	Secondary Adrenal Insufficiency
o	Pituitary or hypothalamic disease 
•	Infections
o	Tuberculosis 
o	Meningococcal septicaemia (Waterhouse-Friderichsen Syndrome)
o	CMV 
o	Histoplasmosis
•	Infiltration
o	Metastasis (mainly from lung, breast, melanoma)
o	Lymphomas
o	Amyloidosis 
•	Infarction
o	Secondary to thrombophilia
•	Inherited
o	Adrenoleukodystrophy
o	ACTH receptor mutation 
•	Surgical 
o	After bilateral adrenalectomy
•	Iatrogenic
o	Sudden cessation of long-term steroid therapy

Question 3

Summarise the epidemiology of adrenal insufficiency

Answer 3

• Most common cause is IATROGENIC

* Primary causes are rare