Adrenal Insufficiency

  • Akhil Khosla
  • Amy M. AhasicEmail author


Adrenal insufficiency with acute crisis is a cause of shock in critically ill patients that may be underdiagnosed. Adrenal insufficiency may result from adrenal, pituitary, or hypothalamic disorders. Medications may also contribute to adrenal insufficiency. Critical illness-related corticosteroid insufficiency (CIRCI) is a relative adrenal insufficiency in which cortisol levels are inadequate for the acute critical illness and is discussed in Chap. 57. Diagnosis of adrenal insufficiency and differentiation of its various etiologies can be accomplished by measuring serum cortisol, ACTH levels, and by challenging the patient with exogenous adrenocorticotropic hormone (ACTH). Glucocorticoid replacement therapy is the mainstay of treatment, along with fluid resuscitation and supportive care. Salt repletion and glucose supplementation may be required, depending on the etiology of adrenal insufficiency. Mineralocorticoid replacement may also be necessary for primary adrenal insufficiency.


Adrenal insufficiency Steroid replacement ACTH stimulation testing Addisonian crisis 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Section of Pulmonary, Critical Care and Sleep MedicineYale University School of MedicineNew HavenUSA
  2. 2.Section of Pulmonary, Critical Care and Sleep MedicineNorwalk Hospital, Nuvance HealthNorwalkUSA

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