Differential Diagnosis for Adrenal Weakness Etiology
Single Most Likely Diagnosis
- Adrenal Insufficiency (Addison's Disease): This condition is characterized by the inadequate production of cortisol and aldosterone, leading to weakness, fatigue, weight loss, and changes in skin pigmentation. It is a primary consideration due to its direct impact on adrenal function.
Other Likely Diagnoses
- Hypopituitarism: A condition where the pituitary gland does not produce one or more of its hormones or not enough of them, which can lead to secondary adrenal insufficiency due to the lack of ACTH (adrenocorticotropic hormone) stimulation on the adrenal glands.
- Congenital Adrenal Hyperplasia (CAH): Although more commonly associated with virilization and other symptoms, certain forms of CAH can lead to adrenal insufficiency, particularly if not adequately managed.
- Adrenal Hemorrhage or Infarction: Sudden loss of adrenal function due to bleeding or infarction can cause acute adrenal insufficiency, presenting with weakness among other symptoms.
Do Not Miss Diagnoses
- Pheochromocytoma: Although typically associated with hypertension, a pheochromocytoma can occasionally present with episodes of weakness, especially if there are significant fluctuations in blood pressure.
- Adrenal Crisis: A life-threatening condition that occurs when the adrenal glands do not produce adequate amounts of cortisol and aldosterone, often requiring immediate medical attention. It can be precipitated by stress, infection, or stopping steroid medication abruptly.
- Waterhouse-Friderichsen Syndrome: A rare but deadly condition caused by adrenal hemorrhage, typically due to severe bacterial infection (e.g., Neisseria meningitidis), leading to adrenal insufficiency and shock.
Rare Diagnoses
- Familial Glucocorticoid Deficiency: A rare genetic disorder affecting the production of cortisol, leading to adrenal insufficiency.
- Triple A Syndrome (Allgrove Syndrome): A rare autosomal recessive disorder characterized by adrenal insufficiency, alacrima (absence of tear secretion), and achalasia (difficulty swallowing).
- Wolman Disease: A rare genetic disorder causing a deficiency of the enzyme lysosomal acid lipase, leading to accumulation of lipids in various body organs, including the adrenal glands, and resulting in adrenal insufficiency.