General Medical Information

Adrenocortical Insufficiency

Jeffrey D. Bunn
Amy R. Coffey
George H. Petti, Jr.

Primary adrenocortical insufficiency (i.e., Addison’s disease) may be due to destruction of the gland from autoimmune disease, tumors, infection, hemorrhage, or metabolic failure in hormone production. Secondary causes are hypopituitarism or suppression by exogenous steroids, ACTH (e.g., autonomous tumors), or endogenous steroids. The disease is characterized by fatigability, weakness, anorexia, nausea and vomiting, weight loss, hyperpigmentation, hypotension, and occasionally hypoglycemia. In women, the loss of adrenal androgens causes a loss of axillary and pubic hair. The absence of glucocorticoid causes volume depletion with decreased cardiac output and function, leading to shock that is sometimes called addisonian crisis.