- caused by autoimmune, infectious (TB, cryptococcus, CMV, pneumocystis), iatrogenic (bilateral adrenalectomy), or metastatic (lung, breast) etiologies
- clinical features related to lack of cortisol: GI symptoms (anorexia, nausea/vomitting, abdominal pain), hypoglycemia, hypotension, hyperpigmentation, intolerance to physiologic stress
- clinical features related to lack of aldosterone: hyponatremia and hypovolemia-->decreased cardiac output and renal perfusion, syncope, shock, hyperkalemia
- tx in acute crisis: several liters of IV fluids (D5NS), IV hydrocortisone, tx underlying condition
- chronic tx: daily oral glucocorticoid, daily mineralocorticoid
Secondary Adrenal Insufficiency
- Causes: long term steroid therapy + illness/trauma
- clinical features: same as above except that hyperpigmentation and hyperkalemia are not seen because ACTH is low, and aldosterone is normal
- tx: same as above except that only glucocorticoid supplementation is necessary
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