Secondary Adrenal Insufficiency

Question 1

What causes secondary adrenal insufficiency?

Answer 1

• Pituitary/hypothalamic disease
• Tumours
• Exogenous steroid use (Most common)

Question 2

Most common cause of secondary adrenal insufficiency?

Answer 2

Exogenous steroid use

Question 3

Presentation of secondary adrenal insufficiency?

Answer 3

SAME features as Addison’s except:

• Pale skin because no increased ACTH
• Aldosterone production is intact (regulated by RAS)

Features of Addison’s:

• Anorexia
• Wt loss
• Dizziness and low BP
• Abdominal pain
• Vomiting
• Diarrhoea
• Skin pigmentation
• Decreased mineralocorticoids and glucocorticoids

Question 4

Management of secondary adrenal insufficiency?

Answer 4

• Treat with hydrocortisone replacement

- Fludrocortisone is UNNECESSARY

Question 5

What is secondary adrenal insufficiency?

Answer 5

Lack of CRH or ACTH