I. Definition
A condition characterized by a deficiency of cortisol, androgens, and aldosterone as the result of destruction of the adrenal cortices
II. Incidence/predisposing factors
A. Incidence is 40 to 60/1,000,000 individuals.
B. Female to male ratio is 2:1.
C. Sudden withdrawal of glucocorticoids (deficiency)
D. Extreme stress
E. Trauma
F. Adrenal hemorrhage, post adrenalectomy
G. Sepsis
H. Tuberculosis
III. Etiology
A. Autoimmune destruction of the adrenal gland
B. Bilateral adrenal hemorrhage (e.g., as a result of anticoagulant therapy)
D. Pituitary failure resulting in decreased levels of adrenocorticotropic hormone (ACTH)
IV. Chronic subjective/physical examination findings
A. Weakness/fatigue
B. Headache
C. Nausea
D. Vomiting
E. Abdominal pain with accompanying diarrhea
F. Hyperpigmentation in the buccal mucosa and skin creases related to excess ACTH
1. Apparent in knuckles, knees, posterior neck, elbows, and palmar creases
2. Signifies a deficiency in cortisol, not in ACTH
G. Sparse axillary hair
H. Hypotension
I. Arthralgias
J. Weight loss
V. Acute subjective/physical examination findings
A. Marked and rapid worsening of the preceding chronic findings
B. Fever
C. Hypovolemia/hypotension
D. Changes in mental status/level of consciousness
VI. Diagnostics/laboratory findings
A. Hyponatremia
B. Hyperkalemia
C. Hypoglycemia
D. Elevated erythrocyte sedimentation rate
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
