Adrenal insufficiency can arise from a primary adrenal disorder, secondary to
adrenocorticotropic hormone deficiency, or by suppression of
adrenocorticotropic hormone by exogenous
glucocorticoid or
opioid medications. Hallmark clinical features are unintentional
weight loss,
anorexia,
postural hypotension, profound fatigue, muscle and
abdominal pain, and hyponatraemia. Additionally, patients with
primary adrenal insufficiency usually develop skin
hyperpigmentation and crave
salt. Diagnosis of
adrenal insufficiency is usually delayed because the initial presentation is often non-specific; physician awareness must be improved to avoid adrenal crisis. Despite state-of-the-art
steroid replacement
therapy, reduced quality of life and work capacity, and increased mortality is reported in patients with primary or secondary
adrenal insufficiency. Active and repeated patient education on managing
adrenal insufficiency, including advice on how to increase medication during intercurrent illness, medical or dental procedures, and profound stress, is required to prevent adrenal crisis, which occurs in about 50% of patients with
adrenal insufficiency after diagnosis. It is good practice for physicians to provide patients with a
steroid card, parenteral
hydrocortisone, and training for parenteral
hydrocortisone administration, in case of
vomiting or severe illness. New modes of
glucocorticoid delivery could improve the quality of life in some patients with
adrenal insufficiency, and further advances in oral and parenteral
therapy will probably emerge in the next few years.