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Running Head: Adrenal insufficiency 1

Adrenal insufficiency

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Adrenal insufficiency 2

Thomas Addison described the clinical presentations of primary adrenocortical

insufficiency in his work in 1855. Addison disease is a condition of adrenocortical insufficiency

caused by dysfunction of the adrenal cortex. The adrenal cortex produces 3 steroid hormones

namely glucocorticoids, mineralocorticoids and androgens which are important in acute adrenal

insufficiency occurs when these hormonal effects are reversed other glands fail to release the

adequate amounts of hormones to meet the bodys physiologic needs. According to studies,

patients with adrenal crisis are at risk of getting infections and severe cases, Bilateral massive

adrenal hemorrhage (BMAH) especially when under stress.

The prevalence of Addison disease is at 4-6% with highest numbers in countries such as

Britain and Denmark. Mortality associated with the condition is always due to delay in diagnosis

and failure to institute adequate replacement and treatment. Death is higher in patients due to

infectious diseases and cardiovascular conditions. The disease is more common in females and

children, in all races and a common presentation in adults aged 30-35 years. Symptoms of the

disease which usually develops slowly over several months include low blood sugar, abdominal

pain, fatigue, hyperpigmentation, weight loss and craving of salt. Addison crisis symptoms

include low blood pressure, severer vomiting and diarrhea, loss of consciousness and high levels

of potassium. it is advisable to seek medical assistance on the onset of these symptoms to prevent

infections and complications.

ACTH tests may be provided during resuscitation of the patient and stress doses in

definitive therapy. However, It is not advisable to delay glucocorticoid replacement therapy

while awaiting ACTH stimulation results. Patients with these symptoms are advised to consult

endocrinologists, infectious disease specialist, cardiologist, critical care physicians and surgeons.

Maintenance and emergency treatment include maintenance of airway to support patient


Adrenal insufficiency 3

breathing and air circulation and the use of coma protocol such as glucose and thiamine. The

patients mineralocorticoid levels should be maintained and one of the recommended drugs is

telaprevir.