Adrenal Insufficiency
Primary (Addison): autoimmune destruction. Symptoms: fatigue, weight loss, hyperpigmentation (ACTH elevated), hyponatremia, hyperkalemia, hypotension. Treatment: hydrocortisone + fludrocortisone. Stress dose steroids for illness/surgery.
Cushing Syndrome
Excess cortisol. Most common: exogenous steroids. Endogenous: pituitary adenoma (Cushing disease, 70%), adrenal tumor, ectopic ACTH. Symptoms: moon face, buffalo hump, central obesity, purple striae, HTN, hyperglycemia, osteoporosis.
Adrenal Crisis
Life-threatening cortisol deficiency. Precipitated by stress, surgery, infection, abrupt steroid withdrawal. Hypotension, shock, abdominal pain, confusion, hypoglycemia, hyponatremia, hyperkalemia. Treatment: IV hydrocortisone 100 mg bolus, aggressive fluids.
Important Notes
- Patients on chronic steroids need stress-dose steroids for illness/surgery — never abruptly stop glucocorticoids.
- Adrenal crisis is life-threatening — treat empirically with IV hydrocortisone before lab confirmation.
Clinical Tips
- Hyperpigmentation (bronze skin) in primary adrenal insufficiency caused by elevated ACTH.
- Check morning cortisol and ACTH — draw at 6-8 AM when cortisol highest.
Summary
Adrenal disorders require appropriate hormone replacement or suppression, stress-dose steroids during illness, and recognition of adrenal crisis.
