Adrenal Insufficiency: Management and Treatment Options

Adrenal insufficiency is a condition characterized by inadequate production of hormones from the adrenal glands. It can be classified into primary, secondary, or tertiary adrenal insufficiency, depending on the underlying cause.

Causes

• Primary adrenal insufficiency (Addison’s disease) – due to autoimmune destruction of the adrenal cortex.
• Secondary adrenal insufficiency – caused by pituitary dysfunction leading to insufficient ACTH production.
• Tertiary adrenal insufficiency – results from hypothalamic dysfunction affecting CRH secretion.

Symptoms

Common symptoms include fatigue, weight loss, hypotension, hyperpigmentation (in Addison’s disease), and gastrointestinal disturbances.

Diagnosis

Diagnosis typically involves:

• Serum cortisol levels
• ACTH stimulation test
• Electrolyte panel
• Imaging studies (CT/MRI for adrenal or pituitary evaluation)

Management and Treatment

Hormone Replacement Therapy

The cornerstone of treatment is hormone replacement therapy:

• Glucocorticoid replacement (hydrocortisone, prednisone, or dexamethasone).
• Mineralocorticoid therapy (fludrocortisone) for primary adrenal insufficiency.

Acute Adrenal Crisis Management

Immediate treatment involves:

• Intravenous hydrocortisone.
• Fluid resuscitation with normal saline.
• Glucose supplementation if hypoglycemia is present.

Long-Term Management

• Regular endocrinology follow-up.
• Stress-dose steroid adjustment in times of illness or surgery.
• Patient education on adrenal crisis prevention.