4/12/2023 0 Comments Secondary adrenal insufficiency![]() ![]() ![]() Serum cortisol levels that remain low even after the administration of exogenous ACTH ( ACTH stimulation test) confirm the diagnosis of primary adrenal insufficiency. Patients with primary adrenal insufficiency tend to additionally develop hyperpigmentation of the skin, mild hyperkalemia, and metabolic acidosis. There may also be a loss of libido as a result of hypoandrogenism. Patients with long-standing adrenal insufficiency can present with postural hypotension, nausea, vomiting, weight loss, anorexia, lethargy, depression, and/or chronic hyponatremia. Decreased levels of ACTH or CRH are seen following sudden cessation of prolonged glucocorticoid therapy and in pituitary/ hypothalamic diseases. Secondary adrenal insufficiency is the result of decreased production of ACTH ( adrenocorticotropic hormone) and tertiary adrenal insufficiency is the result of decreased production of CRH ( corticotropin-releasing hormone) by the hypothalamus. The most frequent cause of primary adrenal insufficiency in the US by far is autoimmune adrenalitis, which can occur sporadically or as a manifestation of polyglandular autoimmune syndromes. ![]() ![]() Primary adrenal insufficiency ( Addison disease) is caused by a disorder of the adrenal glands. Adrenal insufficiency is the decreased production of adrenocortical hormones ( glucocorticoids, mineralocorticoids, and adrenal androgens) and is classified as primary, secondary, or tertiary. ![]()
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