Sandbox:Amd

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Adrenal Insufficiency

Disease	Clinical history/findings							Causes	Investigations/ Laboratory findings				Medical management	Surgical management
	Hypotension	Skin pigmentation/ findings	Fatigue	Anorexia/ Weightloss	Abdominal pain	Muscle weakness	Other history/ findings		Hypo natremia	Cortisol levels	Gold Standard	Other
Differentiating amongst adrenal insufficiencies
Primary adrenal insufficiency	✔	✔	✔	✔	✔	✔		Autoimmune/idiopathic Infections- Tuberculosis, histoplasmosis	✔	↓	Cosyntropin/ ACTH stimulation test
Secondary adrenal insufficiency	±	–	✔	✔	–	±	Hypoglycemia (more than primary adrenal insufficiency) Signs of pituitary tumor- Headache, visual field defects (bitemporal hemianopsia)	Hypopituitarism- Tumors, infections. hemorrhage/trauma Drugs- Chronic steroid therapy and its withdrawal, Opiates Genetic- Combined pituitary hormone deficiency (CPHD), POMC (Proopiomelanocortin) gene deficiency	–	Normal	Cosyntropin/ ACTH stimulation test
Acute adrenal insufficiency	↓↓	±	✔	✔	✔	±	Signs of shock Altered mental status/ Loss of consciousness/ Coma Fever	Infection Trauma Surgery Anesthesia (Etomidate)	✔				I/V 0.9% saline 1-3 liters within 12-24 hours I/V Dexamethasone 4 mg bolus, or, I/V hydrocortisone 50 mg bolus
Differentiating Adrenal Insufficiency from other diseases