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Adrenal insufficiency
Julkaistu 16.12.2011 00.01
Adrenal insufficiency was first described by Thomas Addison in 1855. Although a rare disease it is still a life-threatening condition when presenting as an acute adrenal crisis. Primary adrenal insufficiency is most often caused by autoimmune adrenalitis and secondary adrenal insufficiency by pituitary tumours. Patients with primary adrenal insufficiency typically develop gradual cortisol and aldosterone deficiency and may initially be symptomatic only during stress. The diagnosis is therefore often delayed. Common features and signs are fatigue, weight loss, nausea, salt craving, hyperpigmentation and hypotension. In contrast, patients with secondary adrenal insufficiency suffer from cortisol deficiency only and are not characterized by hyperpigmentation or salt craving. Patients with primary adrenal insufficiency require life-long replacement therapy with hydrocortisone and fludrocortisone and patients with secondary adrenal deficiency hydrocortisone substitution. Patients with adrenal insufficiency have impaired subjective health and increased mortality. Replacement therapy should therefore be optimized and carefully monitored. The current recommended total daily hydrocortisone dose is lower than what was previously recommended.
Camilla Schalin-Jäntti Docent, Endocrinologist Helsinki University Central Hospital, Division of Endocrinology, Department of Medicine camilla.schalin-jantti@hus.fi
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