Clinical manifestations of adrenal insufficiency in adults
- Lynnette K Nieman, MD
Lynnette K Nieman, MD
- Section Editor — Adrenal Disease
- Senior Investigator
- Bethesda, MD
The symptoms and signs of adrenal insufficiency depend upon the rate and extent of loss of adrenal function, whether mineralocorticoid production is preserved, and the degree of stress. The onset of adrenal insufficiency is often very gradual and it may go undetected until an illness or other stress precipitates adrenal crisis.
The acute and chronic clinical manifestations of adrenal insufficiency in adults are reviewed here. The causes, diagnosis, and treatment of the different forms of adrenal insufficiency are reviewed separately. (See "Causes of primary adrenal insufficiency (Addison's disease)" and "Causes of secondary and tertiary adrenal insufficiency in adults" and "Diagnosis of adrenal insufficiency in adults" and "Treatment of adrenal insufficiency in adults".)
The syndrome of adrenal crisis (acute adrenal insufficiency) in adults may occur in the following situations:
- In a previously undiagnosed patient with primary adrenal insufficiency who has been subjected to serious infection or other acute, major stress.
- In a patient with known primary adrenal insufficiency who does not take more glucocorticoid during an infection or other major illness, or has persistent vomiting caused by viral gastroenteritis or other gastrointestinal disorders.
- After bilateral adrenal infarction or bilateral adrenal hemorrhage.
- Less frequently in patients with secondary or tertiary adrenal insufficiency during acute stress, but is sometimes seen with acute cortisol deficiency due to pituitary infarction. (See 'Pituitary apoplexy' below.)
- In patients who are abruptly withdrawn from doses of glucocorticoid that cause secondary adrenal insufficiency. Importantly, this includes not only oral but inhaled medications .
The predominant manifestation of adrenal crisis is shock, but the patients often have nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion or coma (table 1).
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- ADRENAL CRISIS
- Primary adrenal insufficiency
- Bilateral adrenal injury, hemorrhage, and infarction
- Pituitary apoplexy
- CHRONIC PRIMARY ADRENAL INSUFFICIENCY
- Common features
- Gastrointestinal complaints
- Electrolyte abnormalities
- Sexual dysfunction
- Musculoskeletal symptoms
- Auricular-cartilage calcification
- Psychiatric manifestations
- SECONDARY OR TERTIARY ADRENAL INSUFFICIENCY
- INFORMATION FOR PATIENTS