Interní Med. 2011; 13(4): 163-166

Patient with adrenocortical insufficiency in internist’s office

prof.MUDr.Michal Kršek, CSc.

3. interní klinika –, klinika endokrinologie a metabolizmu, 1. LF UK a VFN v Praze

Adrenocortical insufficiency (AI) is a condition characterized by decreased secretion of steroid hormones from adrenal cortex. Primary

AI is characterised by deficiency of all adrenocortical steroids, secondary AI is characterised mainly by deficiency of glucocorticoids

while secretion of mineralocorticoids is mostly preserved. Clinical presentation of chronic AI consists mainly of non-specific signs as

tiredness and weakness, however is can progress to more severe forms with hypotension, tachycardia, abdominal pain, hypoglycaemia,

hyperkalemia, acidosis and even circulatory failure with a threat of death. Therefore, there is a need for early and precise diagnosis and

proper treatment of AI. The secretion of glucocorticoids could be roughly estimated by assessment of basal serum levels of cortisol.

However, the use of dynamic testing of hypothalamic-pituitary-adrenal axis is indicated under certain circumstances. The treatment of

chronic AI consists of hormonal replacement therapy with glucocorticoids with a need for an increase in dose during stress situations. The

acute AI needs to be treated with high doses of glucocorticoids given parenteraly. In most cases with primary AI also mineralocorticoid

replacement usually in fixed dose is indicated.

Keywords: adrenal cortex, insufficiency, hypocorticism, Addison disease, diagnosis, treatment

Published: April 13, 2011  Show citation