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Clinical manifestations of adrenal insufficiency in adults

Lynnette K Nieman, MD
Section Editor
André Lacroix, MD
Deputy Editor
Kathryn A Martin, 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".)


Main features — 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). In one study, the incidence of adrenal crisis was similar in patients with primary (8 percent) and secondary (6 percent) causes of adrenal insufficiency [1].

Major precipitating factors — As suggested by its occurrence in both causes of adrenal insufficiency, both mineralocorticoid and glucocorticoid deficiency can participate in the development of adrenal crisis. The physiologic basis for this is the ability of aldosterone or synthetic mineralocorticoid to promote sodium retention as well as to enhance vasoconstrictor responses of the vasculature [2]. Thus, adrenal crisis can occur in patients who are receiving physiologic or even pharmacologic doses of synthetic glucocorticoid if their mineralocorticoid requirements are not met [3,4]. Glucocorticoid deficiency can contribute to hypotension by causing decreased vascular responsiveness to angiotensin II and norepinephrine, decreased synthesis of renin substrate, and increased prostacyclin production [5-7].

There is almost always an acute stressor or cause of adrenal insufficiency in patients with adrenal crisis. These should be sought in the clinical settings below.

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Literature review current through: Nov 2017. | This topic last updated: Mar 08, 2017.
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