Adrenal Insufficiency

Diagnosis

  • Signs and Symptoms (percent)
    • Addison's disease
      • Weakness and fatigue (94)
      • Weight loss (90)
      • Anorexia (80)
      • Nausea and vomiting (66)
      • GI symptoms (61)
    • Acute adrenal insufficiency
      • Severe clinical deterioration (100)
      • Fevers (70)
      • Nausea and vomiting (64)
      • Abdominal pain (46)
  • Laboratory
    • Hyponatremia
    • Hyperkalemia
    • Azotemia
  • Low plasma cortisol.
  • Failure to increase plasma or urinary corticosteroid levels to the normal range with ACTH infusion; 0.25 cosyntropin given IV: measure plasma cortisol before and 60 min later (normal cortisol responses is a rise above 18 ug/dL).

Treatment

  • Stress level steroids (8 to 10 mg dexamethasone)
  • Saline
  • Correct hyperkalemia

References

  • Blumenfeld JD, Schlusse, Sealey JE, et al: Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med, 121:877-885, 1994.
  • Blumenfeld JD, Vaughan ED Jr.: The adrenals. In: Campbell's Urology. 7th Ed. Philadelphia, Saunders, 1998, pp. 2915-2971.
  • Manger WM, Gifford RW Jr.: Pheochromocytoma. A clinical review. In: Hypertension Pathophysiology, Diagnosis, and Management. Laragh JH, Brenner BM, eds. 1995, pp. 2225-2246.
  • Orth DN: Cushing syndrome. N Eng J Med 332:791-795, 1995.
  • Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC: Successful outcomes in pheochromocytoma surgery in the modern era. J Urol 161:764-767, 1999. Vaughan ED Jr.: Adrenal surgery. F. F. Marshall, Ed. In: Textbook of Operative Surgery. Philadelphia, Saunders, 1996, p 220-230.
  • Vaughan ED Jr., (ed): Diagnosis and treatments of adrenal disorders. World J Urol 17:1064, 1999.