Overview

• Primary adrenal insufficiency → decreased production of adrenocortical hormones (reduced cortisol and aldosterone)
• F>M
• Causes → Autoimmune (more developed countries) & Tuberculosis (more common worldwide)
  • May also be caused by metastases (eg. bronchial carcinoma)
• Risk Factors → female, presence of adrenocortical autoantibodies, adrenal haemorrhage, anticoagulant use
• Addisonian Crisis ⇒ may be precipitated by sudden withdrawal of steroids if patient on long-term steroid medication, sepsis or surgery.

Making Diagnosis

Clinical Features:

• Fatigue
• Abdominal Pain
• Weight Loss
• Hyperpigmentation → -ve feedback causes increased ACTH leading to increased POMC, leading to increased α-MSH
• Nausea, Vomiting, Hypotension
• Hypoglycaemia → may cause dizziness and falls

Addisonian Crisis ⇒ severe hypovolaemia and hyponatraemia

Investigations: