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Primary adrenal insufficiency predisposes to higher risk of death, mostly due to infection, cardiovascular disease, and adrenal crisis. [2] Delayed diagnosis can impair quality of life, and lack of treatment brings high mortality. [2] However, with proper diagnosis, monitoring, and treatment, people with adrenal insufficiency can live normally. [3]
The treatment of pituitary tumors and the widespread use of opioids for pain, as well as exogenous glucocorticoid therapy for the numerous conditions that become more common in people over 60, are the main causes of a new diagnosis of adrenal insufficiency in older adults. [43] [44] Adrenal crisis is more likely to occur in older people. [45]
Rapid onset of symptoms indicates acute adrenal failure, which is a clinical emergency. [5] An adrenal crisis can be triggered by stress, such as from an injury, surgery, or infection. [1] Addison's disease arises when the adrenal gland does not produce sufficient amounts of the steroid hormones cortisol and (sometimes) aldosterone. [1]
Adrenal crisis is a serious, life-threatening complication of adrenal insufficiency. Hypotension , or hypovolemic shock , is the main symptom of adrenal crisis, other indications and symptoms include weakness , anorexia , nausea , vomiting, fever, fatigue , abnormal electrolytes , confusion , and coma. [ 19 ]
This is often followed by acute symptoms caused by lack of secretion of essential hormones, predominantly adrenal insufficiency. [1] The diagnosis is achieved with magnetic resonance imaging and blood tests. Treatment is by the timely correction of hormone deficiencies. In many cases, surgical decompression is required.
Adrenal hemorrhage characteristic of the Waterhouse–Friderichsen syndrome has been identified in several autopsies of patients who died of sepsis secondary to capnocytophaga canimorsus infection. [8] Viruses may also be implicated in adrenal problems: Cytomegalovirus can cause adrenal insufficiency, [9] especially in the immunocompromised.
Adrenal insufficiency Before 7.5 years Up to 50% in childhood, varies with age Asymptomatic No clinical presentation, further studies can reveal subclinical adrenal insufficiency or mild AMN phenotype Most common phenotype in boys under four years of age Proportion of asymptomatic patients decreases with age
A low-dose ACTH stimulation test has been suggested as a sensitive test for secondary adrenal insufficiency diagnosis. [10] When compared to insulin tolerance testing [11] and the high-dose ACTH test, this test allows for a more accurate identification of patients with secondary adrenal insufficiency. [12]