Abstract
The adrenal glands produce corticosteroids, mineralocorticoids and adrenal androgens. Adrenal insufficiency may be caused by primary adrenal failure or by impairment of hypothalamic-pituitary-adrenal axis. Adrenal insufficiency is life threatening when diagnosis is missed. The main symptoms include weight loss, fatigue, anorexia and dizziness. A stepwise diagnostic work up is required to identify the underlying cause of adrenal insufficiency. The treatment of adrenal insufficiency requires glucocorticoid and mineralocorticoid replacement therapy, which requires careful monitoring. The long-term management of patients with adrenal insufficiency requires experienced specialist care. All doctors should know how to diagnose and manage acute adrenal failure.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Miller WL, Auchus RJ. The molecular biology, biochemistry, and physiology of human steroidogenesis and its disorders. Endocr Rev. 2011;32:81–151.
Charmandari E, Tsigos C, Chrousos G. Endocrinology of the stress response. Annu Rev Physiol. 2005;67:259–84.
Erichsen MM, Løvås K, Skinningsrud B, Wolff AB, Undlien DE, Svartberg J, et al. Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry. J Clin Endocrinol Metab. 2009;94:4882–90.
Mason AS, Meade TW, Lee JA, Morris JN. Epidemiological and clinical picture of Addison’s disease. Lancet. 1968;2:744–7.
Lovas K, Husebye ES. High prevalence and increasing incidence of Addison’s disease in western Norway. Clin Endocrinol (Oxf). 2002;56:787–91.
Bornstein SR. Predisposing factors for adrenal insufficiency. N Engl J Med. 2009;360:2328–39.
Neary N, Nieman L. Adrenal insufficiency: etiology, diagnosis and treatment. Curr Opin Endocrinol Diabetes Obes. 2010;17:217–23.
Hägg E, Asplund K, Lithner F. Value of basal plasma cortisol assays in the assessment of pituitary-adrenal insufficiency. Clin Endocrinol (Oxf). 1987;26:221–6.
Le Roux CW, Meeran K, Alaghband-Zadeh J. Is a 0900-h serum cortisol useful prior to a short synacthen test in outpatient assessment? Ann Clin Biochem. 2002;39:148–50.
Schmidt IL, Lahner H, Mann K, Petersenn S. Diagnosis of adrenal insufficiency: evaluation of the corticotropin-releasing hormone test and Basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic-pituitary-adrenal disease. J Clin Endocrinol Metab. 2003;88:4193–8.
Arlt W. The approach to the adult with newly diagnosed adrenal insufficiency. J Clin Endocrinol Metab. 2009;94:1059–67.
Azziz R, Bradley Jr E, Huth J, Boots LR, Parker Jr CR, Zacur HA. Acute adrenocorticotrophin (1-24) (ACTH)adrenal stimulation in eumenorrheic women: reproducibility and effect of ACTH dose, subject weight, and sampling time. J Clin Endocrinol Metab. 1990;70:1273–9.
Grossman AB. Clinical Review: The diagnosis and management of central hypoadrenalism. J Clin Endocrinol Metab. 2010;95:4855–63.
Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet. 2014;383:2152–67.
Grinspoon SK, Biller BM. Clinical review 62: laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab. 1994;79:923–31.
Wallace I, Cunningham S, Lindsay J. The diagnosis and investigation of adrenal insufficiency in adults. Ann Clin Biochem. 2009;46:351–67.
Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009;23:167–79.
Quinkler M, Hahner S. What is the best long-term management strategy for patients with primary adrenal insufficiency? Clin Endocrinol (Oxf). 2012;76:21–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag London
About this chapter
Cite this chapter
Mbagaya, W., Orme, S.M. (2015). Weight Loss and Dizziness: Adrenal Failure. In: Ajjan, R., Orme, S. (eds) Endocrinology and Diabetes. Springer, London. https://doi.org/10.1007/978-1-4471-2789-5_12
Download citation
DOI: https://doi.org/10.1007/978-1-4471-2789-5_12
Publisher Name: Springer, London
Print ISBN: 978-1-4471-2788-8
Online ISBN: 978-1-4471-2789-5
eBook Packages: MedicineMedicine (R0)