From the Research
Adrenal insufficiency workup should be considered in patients of any age who present with suggestive symptoms. In neonates and infants, consider evaluation when there is failure to thrive, recurrent hypoglycemia, salt-wasting, or ambiguous genitalia, as suggested by 1. In children and adolescents, workup is warranted with unexplained fatigue, weight loss, abdominal pain, or delayed puberty. For adults, testing is appropriate with unexplained fatigue, weight loss, postural hypotension, hyperpigmentation, hyponatremia, or hyperkalemia. Particular attention should be given to patients with autoimmune disorders, those on chronic glucocorticoid therapy being tapered, patients with pituitary disorders, or those who have undergone adrenal surgery, as indicated by 2, 3, 4, 5. The initial screening test is typically a morning cortisol level or ACTH stimulation test. The underlying pathophysiology involves insufficient cortisol production, either from primary adrenal gland dysfunction or secondary to pituitary/hypothalamic issues, leading to metabolic derangements and inability to respond to physiologic stress. Early diagnosis is critical as untreated adrenal insufficiency can lead to life-threatening adrenal crisis, especially during illness or stress, as highlighted by 2. Some key points to consider in the workup and management of adrenal insufficiency include:
- The importance of a high index of suspicion for adrenal insufficiency in patients with non-specific symptoms, as emphasized by 1, 3, 5
- The role of glucocorticoid replacement therapy in managing adrenal insufficiency, as discussed by 2, 4
- The need for careful monitoring and adjustment of glucocorticoid doses to prevent adrenal crisis, as noted by 2, 3
- The potential benefits and limitations of dehydroepiandrosterone replacement therapy in improving quality of life for patients with adrenal insufficiency, as mentioned by 4. Overall, a thorough understanding of the pathophysiology, diagnosis, and management of adrenal insufficiency is essential for providing optimal care to patients with this condition, as supported by the evidence from 1, 2, 3, 4, 5.