Secondary adrenal insufficiency history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Iqra Qamar M.D.[3]

Overview

The most common symptoms of secondary adrenal insufficiency include chronic fatigue, weight loss, and visual field defects.

History and Symptoms

History

Patients with secondary adrenal insufficiency may have a positive history of:

Visual field defects
Fatigue
Pituitary radiation or surgery
Traumatic brain injury
Peptic ulcer disease

Common Symptoms

Patients with secondary adrenal insufficiency usually present with features similar to chronic adrenal insufficiency and hypopituitarism:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

Less common symptoms

Less common symptoms may include:^[12]^[13]^[14]^[15]^[6]^[7]^[16]^[17]

Dehydration
Delayed gastric emptying
Steatorrhea
Flexion contraction of legs
Psychiatric symptoms such as

Symptoms of Addisonian crisis

Symptoms of Addisonian crisis include:

Dizziness
Fatigue
Anorexia
Sharp, sudden pain in the abdomen, legs, or lower back
Severe vomiting and diarrhea
Dehydration
Loss of consciousness
Hypoglycemia

If associated with hypopituitarism, patient may present with any one of the following symptom according to the respective hormonal deficiency

Pituitary gland	Hormone	Symptoms of deficiency
Anterior pituitary	Adrenocorticotrophic Hormone (ACTH)	The most critical hormonal deficiency associated with hypopituitarism.^[18]^[1] Nausea and vomiting Fatigue Abdominal pain Weight loss Chest pain Confusion (hypoglycemia)
	Growth Hormone (GH)	Short stature (in children) Fatigue Decreased tolerance of exercise Decreased social functioning Increased cardiovascular risk Decrease muscle mass Decrease bone mineral density which may lead to osteoporosis^[19]
	Gonadotropin hormones: Luteinizing Hormone (LH) Follicle Stimulating Hormone (FSH)	In men: Loss of libido Erectile dysfunction Decreased volume of ejaculate Hot flashes Decrease bone mass Reduced energy and vitality Infertility In women:^[20] Amenorrhea Oligomenorrhea Dyspareunia Decreased libido Hot flashes Vaginal dryness Infertility
	Thyroid Stimulating Hormone (TSH)	Constipation Cold intolerance Weight gain Dry skin Hoarseness Edema Depression Menorrhagia Arthralgia Psychomotor retardation
	Prolactin	Postpartum lactation failure
Posterior pituitary	Oxytocin	Muscle aches Decreased milk ejection during lactation Sleep disturbance Anxiety
Posterior pituitary	Anti Diuretic Hormone (ADH)	Polyuria Polydipsia Nocturia

References

↑ ^1.0 ^1.1 Bancos I, Hahner S, Tomlinson J, Arlt W (2015). "Diagnosis and management of adrenal insufficiency". Lancet Diabetes Endocrinol. 3 (3): 216–26. doi:10.1016/S2213-8587(14)70142-1. PMID 25098712.
↑ Erichsen MM, Løvås K, Skinningsrud B, Wolff AB, Undlien DE, Svartberg J, Fougner KJ, Berg TJ, Bollerslev J, Mella B, Carlson JA, Erlich H, Husebye ES (2009). "Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry". J. Clin. Endocrinol. Metab. 94 (12): 4882–90. doi:10.1210/jc.2009-1368. PMID 19858318.
↑ Mitchell AL, Pearce SH (2012). "Autoimmune Addison disease: pathophysiology and genetic complexity". Nat Rev Endocrinol. 8 (5): 306–16. doi:10.1038/nrendo.2011.245. PMID 22290360.
↑ DUNLOP D (1963). "EIGHTY-SIX CASES OF ADDISON'S DISEASE". Br Med J. 2 (5362): 887–91. PMC 1873052. PMID 14067675.
↑ Piédrola G, Casado JL, López E, Moreno A, Perez-Elías MJ, García-Robles R (1996). "Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome". Clin. Endocrinol. (Oxf). 45 (1): 97–101. PMID 8796145.
↑ ^6.0 ^6.1 Burke CW (1985). "Adrenocortical insufficiency". Clin Endocrinol Metab. 14 (4): 947–76. PMID 3002680.
↑ ^7.0 ^7.1 Stacpoole PW, Interlandi JW, Nicholson WE, Rabin D (1982). "Isolated ACTH deficiency: a heterogeneous disorder. Critical review and report of four new cases". Medicine (Baltimore). 61 (1): 13–24. PMID 6276646.
↑ Bleicken B, Hahner S, Ventz M, Quinkler M (2010). "Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients". Am. J. Med. Sci. 339 (6): 525–31. doi:10.1097/MAJ.0b013e3181db6b7a. PMID 20400889.
↑ JARVIS JL, JENKINS D, SOSMAN MC, THORN GW (1954). "Roentgenologic observations in Addison's disease; a review of 120 cases". Radiology. 62 (1): 16–29. doi:10.1148/62.1.16. PMID 13134487.
↑ Valenzuela GA, Smalley WE, Schain DC, Vance ML, McCallum RW (1987). "Reversibility of gastric dysmotility in cortisol deficiency". Am. J. Gastroenterol. 82 (10): 1066–8. PMID 2821798.
↑ Tobin MV, Aldridge SA, Morris AI, Belchetz PE, Gilmore IT (1989). "Gastrointestinal manifestations of Addison's disease". Am. J. Gastroenterol. 84 (10): 1302–5. PMID 2801683.
↑ Ebinger G, Six R, Bruyland M, Somers G (1986). "Flexion contractures: a forgotten symptom in Addison's disease and hypopituitarism". Lancet. 2 (8511): 858. PMID 2876295.
↑ Shapiro MS, Trebich C, Shilo L, Shenkman L (1988). "Myalgias and muscle contractures as the presenting signs of Addison's disease". Postgrad Med J. 64 (749): 222–3. PMC 2428840. PMID 2845381.
↑ Leigh H, Kramer SI (1984). "The psychiatric manifestations of endocrine disease". Adv Intern Med. 29: 413–45. PMID 6369931.
↑ Anglin RE, Rosebush PI, Mazurek MF (2006). "The neuropsychiatric profile of Addison's disease: revisiting a forgotten phenomenon". J Neuropsychiatry Clin Neurosci. 18 (4): 450–9. doi:10.1176/jnp.2006.18.4.450. PMID 17135373.
↑ Charmandari E, Nicolaides NC, Chrousos GP (2014). "Adrenal insufficiency". Lancet. 383 (9935): 2152–67. doi:10.1016/S0140-6736(13)61684-0. PMID 24503135.
↑ Cuesta M, Garrahy A, Slattery D, Gupta S, Hannon AM, Forde H, McGurren K, Sherlock M, Tormey W, Thompson CJ (2016). "The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study". Clin. Endocrinol. (Oxf). 85 (6): 836–844. doi:10.1111/cen.13128. PMID 27271953.
↑ Burke, C.W. (1985). "Adrenocortical insufficiency". Clinics in Endocrinology and Metabolism. 14 (4): 947–976. doi:10.1016/S0300-595X(85)80084-0. ISSN 0300-595X.
↑ Murray RD, Columb B, Adams JE, Shalet SM (2004). "Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly". J Clin Endocrinol Metab. 89 (3): 1124–30. doi:10.1210/jc.2003-030685. PMID 15001597.
↑ Miller KK, Biller BM, Hier J, Arena E, Klibanski A (2002). "Androgens and bone density in women with hypopituitarism". J Clin Endocrinol Metab. 87 (6): 2770–6. doi:10.1210/jcem.87.6.8557. PMID 12050248.

Template:WikiDoc Sources

[pmid25098712-1] 1.0 ^1.1 Bancos I, Hahner S, Tomlinson J, Arlt W (2015). "Diagnosis and management of adrenal insufficiency". Lancet Diabetes Endocrinol. 3 (3): 216–26. doi:10.1016/S2213-8587(14)70142-1. PMID 25098712.

[pmid19858318-2] Erichsen MM, Løvås K, Skinningsrud B, Wolff AB, Undlien DE, Svartberg J, Fougner KJ, Berg TJ, Bollerslev J, Mella B, Carlson JA, Erlich H, Husebye ES (2009). "Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry". J. Clin. Endocrinol. Metab. 94 (12): 4882–90. doi:10.1210/jc.2009-1368. PMID 19858318.

[pmid22290360-3] Mitchell AL, Pearce SH (2012). "Autoimmune Addison disease: pathophysiology and genetic complexity". Nat Rev Endocrinol. 8 (5): 306–16. doi:10.1038/nrendo.2011.245. PMID 22290360.

[pmid14067675-4] DUNLOP D (1963). "EIGHTY-SIX CASES OF ADDISON'S DISEASE". Br Med J. 2 (5362): 887–91. PMC 1873052. PMID 14067675.

[pmid8796145-5] Piédrola G, Casado JL, López E, Moreno A, Perez-Elías MJ, García-Robles R (1996). "Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome". Clin. Endocrinol. (Oxf). 45 (1): 97–101. PMID 8796145.

[pmid3002680-6] 6.0 ^6.1 Burke CW (1985). "Adrenocortical insufficiency". Clin Endocrinol Metab. 14 (4): 947–76. PMID 3002680.

[pmid6276646-7] 7.0 ^7.1 Stacpoole PW, Interlandi JW, Nicholson WE, Rabin D (1982). "Isolated ACTH deficiency: a heterogeneous disorder. Critical review and report of four new cases". Medicine (Baltimore). 61 (1): 13–24. PMID 6276646.

[pmid20400889-8] Bleicken B, Hahner S, Ventz M, Quinkler M (2010). "Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients". Am. J. Med. Sci. 339 (6): 525–31. doi:10.1097/MAJ.0b013e3181db6b7a. PMID 20400889.

[pmid13134487-9] JARVIS JL, JENKINS D, SOSMAN MC, THORN GW (1954). "Roentgenologic observations in Addison's disease; a review of 120 cases". Radiology. 62 (1): 16–29. doi:10.1148/62.1.16. PMID 13134487.

[pmid2821798-10] Valenzuela GA, Smalley WE, Schain DC, Vance ML, McCallum RW (1987). "Reversibility of gastric dysmotility in cortisol deficiency". Am. J. Gastroenterol. 82 (10): 1066–8. PMID 2821798.

[pmid2801683-11] Tobin MV, Aldridge SA, Morris AI, Belchetz PE, Gilmore IT (1989). "Gastrointestinal manifestations of Addison's disease". Am. J. Gastroenterol. 84 (10): 1302–5. PMID 2801683.

[pmid2876295-12] Ebinger G, Six R, Bruyland M, Somers G (1986). "Flexion contractures: a forgotten symptom in Addison's disease and hypopituitarism". Lancet. 2 (8511): 858. PMID 2876295.

[pmid2845381-13] Shapiro MS, Trebich C, Shilo L, Shenkman L (1988). "Myalgias and muscle contractures as the presenting signs of Addison's disease". Postgrad Med J. 64 (749): 222–3. PMC 2428840. PMID 2845381.

[pmid6369931-14] Leigh H, Kramer SI (1984). "The psychiatric manifestations of endocrine disease". Adv Intern Med. 29: 413–45. PMID 6369931.

[pmid17135373-15] Anglin RE, Rosebush PI, Mazurek MF (2006). "The neuropsychiatric profile of Addison's disease: revisiting a forgotten phenomenon". J Neuropsychiatry Clin Neurosci. 18 (4): 450–9. doi:10.1176/jnp.2006.18.4.450. PMID 17135373.

[pmid24503135-16] Charmandari E, Nicolaides NC, Chrousos GP (2014). "Adrenal insufficiency". Lancet. 383 (9935): 2152–67. doi:10.1016/S0140-6736(13)61684-0. PMID 24503135.

[pmid27271953-17] Cuesta M, Garrahy A, Slattery D, Gupta S, Hannon AM, Forde H, McGurren K, Sherlock M, Tormey W, Thompson CJ (2016). "The contribution of undiagnosed adrenal insufficiency to euvolaemic hyponatraemia: results of a large prospective single-centre study". Clin. Endocrinol. (Oxf). 85 (6): 836–844. doi:10.1111/cen.13128. PMID 27271953.

[Burke1985-18] Burke, C.W. (1985). "Adrenocortical insufficiency". Clinics in Endocrinology and Metabolism. 14 (4): 947–976. doi:10.1016/S0300-595X(85)80084-0. ISSN 0300-595X.

[pmid15001597-19] Murray RD, Columb B, Adams JE, Shalet SM (2004). "Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly". J Clin Endocrinol Metab. 89 (3): 1124–30. doi:10.1210/jc.2003-030685. PMID 15001597.

[pmid12050248-20] Miller KK, Biller BM, Hier J, Arena E, Klibanski A (2002). "Androgens and bone density in women with hypopituitarism". J Clin Endocrinol Metab. 87 (6): 2770–6. doi:10.1210/jcem.87.6.8557. PMID 12050248.

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