Skip to main content

Advertisement

Log in

Adrenal insuficiency: Diagnosis and management

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Adrenal insuficiency is a disorder characterized by hypoactive adrenal glands resulting in insuficient production of the hormones cortisol and aldosterone by the adrenal cortex. This disorder may develop as a primary failure of the adrenal cortex or be secondary to an abnormality of the hypothalamic-pituitary axis. Patients with adrenal insuficiency often are asymptomatic or they may present with fatigue, muscle weakness, weight loss, low blood pressure, and sometimes darkening of the skin. The presentation of adrenal insuficiency varies dramatically and poses a major diagnostic dilemma. This review focuses on the diagnosis and treatment of primary and secondary adrenal insuificency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Williams GH, Dluhy RG: Disorders of the adrenal cortex. In Harrison’s Principles of Internal Medicine. Edited by Kasper DL, Braunwald E, Fauci AS, et al. New York: McGraw-Hill; 2005:2127.

    Google Scholar 

  2. Addison T: On the Constitutional and Local Effects of Disease of the Supra-renal Capsules. London: Highley; 1855. This is the initial and hallmark original report of PAI (Addison’s disease).

    Google Scholar 

  3. Lovas K, Husebye ES: High prevalence and increasing incidence of Addison’s disease in Western Norway. Clin Endocrinol 2002, 56:787–791.

    Article  Google Scholar 

  4. Martin MP, Roep BO, Smith JW: Autoimmunity in Addison’s disease. Neth J Med 2002, 60:269. This manuscript is significant in reviewing the causes of Addison’s disease and highlights the primary cause of adrenal insuficiency in developed countries.

    Google Scholar 

  5. Margaretten W, Nakai H, Landing BH: Septicemic adrenal hemorrhage. Am J Dis Child 1963, 105:346–351.

    PubMed  CAS  Google Scholar 

  6. Migeon CJ, Kenny FM, Hung W, et al.: Study of adrenal function in children with meningitis. Pediatrics 1967, 40:163–183.

    PubMed  CAS  Google Scholar 

  7. Siu SC, Kitzman DW, Sheedy PF, et al.: Adrenal insufficiency from bilateral adrenal hemorrhage. Mayo Clin Proc 1990, 65:664–670.

    PubMed  CAS  Google Scholar 

  8. Caron P, Chabannier MH, Cambus JP, et al.: Definitive adrenal insuficiency due to bilateral adrenal hemorrhage and primary antiphospholipid syndrome. J Clin Endocrinol Metab 1998, 83:1437–1439.

    Article  PubMed  CAS  Google Scholar 

  9. Sonino N: The use of ketoconazole as an inhibitor of steroid production. N Engl J Med 1987, 317:1204.

    Google Scholar 

  10. Kobayashi K, Weiss RE, Vogelzang NJ, et al.: Mineralocorticoid insuficiency due to suramin therapy. Cancer 1996, 78:2411–2420.

    Article  Google Scholar 

  11. Elias AN, Gwinup G: Effects of some clinically encountered drugs on steroid synthesis and degradation. Metabolism 1989, 29:582–595.

    Article  Google Scholar 

  12. Redman BG, Pazdur R, Zingas AP, et al.: Prospective evaluation of adrenal insuficiency in patients with adrenal metastasis. Cancer 1987, 60:103–107.

    Article  PubMed  CAS  Google Scholar 

  13. Kennedy RL, Ball RY, Dixon AK, et al.: Metastatic transitional cell carcinoma of the bladder causing Addison’s disease. J Urol 1987, 137:986–988.

    PubMed  CAS  Google Scholar 

  14. Glasgow BJ, Steinsapir KD, Anders K, Layfield LJ: Adrenal pathology in the acquired immune deficiency syndrome. Am J Clin Pathol 1985, 84:594–597.

    PubMed  CAS  Google Scholar 

  15. Oelkers W: Adrenal insuficiency. N Engl J Med 1996, 335:1206–1212.

    Article  Google Scholar 

  16. Vaughan ED Jr, Blumenfeld JD, Del Pizzo JJ, et al.: The adrenals. In Campbell’s Urology. Edited by Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ. Philadelphia: Saunders Press; 2002:3507.

    Google Scholar 

  17. Barnett AH, Espiner EA, Donald RA: Patients presenting with Addison’s disease need not be pigmented. Postgrad Med J 1982, 58:690–692. This report highlights unique cases of adrenal insuficiency without signs of hyperpigmentation, which presents a diagnostic challenge.

    PubMed  CAS  Google Scholar 

  18. Tobin MV, Aldridge SA, Morris AI, et al.: Gastrointestinal manifestations of Addison’s disease. Am J Gastroenterol 1989, 84:1302–1305.

    PubMed  CAS  Google Scholar 

  19. Letizia C, Cerci S, Centanni M, et al.: High levels of endothelin-1 in untreated Addison’s disease. Eur J Endocrinol 1996, 135:696–699.

    Google Scholar 

  20. Leigh H, Kramer SI: The psychiatric manifestations of endocrine disease. Adv Intern Med 1984, 29:413–445.

    PubMed  CAS  Google Scholar 

  21. Claussen MS, Landercasper J, Cogbill TH: Acute adrenal insuficiency presenting as shock after trauma and surgery: three cases and review of literature. J Trauma 1992, 32:94–100.

    Article  PubMed  CAS  Google Scholar 

  22. Schlaghecke R, Kornely E, Santen RT, et al.: The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med 1992, 326:226–230.

    Article  PubMed  CAS  Google Scholar 

  23. Niewman LK: Treatment of adrenal insuficiency. http://www.uptodate.com. Accessed April 2005.

  24. Angermeier KW, Montie JE: Perioperative complications of adrenal surgery. Urol Clin North Am 1989, 16:597–606.

    PubMed  CAS  Google Scholar 

  25. Axelrod L: Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin N Am 2003, 32:367–383. This is an important review of the perioperative management of patients treated with synthetic glucocorticoids.

    Article  CAS  Google Scholar 

  26. Ligtenberg JJ, Zijlstra JG: The relative adrenal insuficiency syndrome revisited: Which patients will benefit from low-dose steroids? Curr Opin Crit Care 2004, 10:456–460. This is a thorough review of the diagnosis and management of adrenal insufIciency in critical care patients with sepsis.

    Article  PubMed  Google Scholar 

  27. Nakada T, Kubota Y, Sasagawa I, et al.: Therapeutic outcomes of primary aldosteronism: adrenalectomy versus enucleation of aldosterone-producing adenoma. J Urol 1995, 153:1775–1780.

    Article  PubMed  CAS  Google Scholar 

  28. Munver R, Del Pizzo JJ, Sosa RE: Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Curr Urol Rep 2003, 4:87–92. This is the first published review of laparoscopic adrenal-preserving surgery for functional adrenal lesions.

    Article  PubMed  Google Scholar 

  29. Itoh N, Kunishima Y, Tanaka T, et al.: Is laparoscopic adrenal-sparing surgery for aldosterone-producing tumor really appropriate [Abstract]? Presented at the World Congress on Endourology and SWL 23rd Annual Meeting. J Endourol 2005, 19 suppl 1. This series reports microscopic adenomas being present concomitantly with macroscopic adenomas in four of 38 adrenal glands removed laparoscopically. The authors caution against the use of partial adrenalectomy because microadenomas can be missed.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ravi Munver MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Munver, R., Volfson, I.A. Adrenal insuficiency: Diagnosis and management. Curr Urol Rep 7, 80–85 (2006). https://doi.org/10.1007/s11934-006-0046-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-006-0046-5

Keywords

Navigation