Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

Signs and symptoms of adrenal insufficiency are listed in Table 534-1. Most patients with chronic adrenal insufficiency have weakness, fatigue, anorexia, weight loss, hypotension, and hyperpigmentation. Patients with acute adrenal insufficiency may have hypotension, shock, weakness, apathy, confusion, anorexia, nausea, vomiting, dehydration, abdominal or flank pain, hyperthermia, and hypoglycemia. Deficient adrenal androgen secretion will compromise the acquisition of virilizing secondary sexual characteristics (pubic and axillary hair, acne, axillary odor) in female adolescents.

Table 534-1. Signs and Symptoms of Adrenal Insufficiency

Many conditions will cause adrenal insufficiency, including congenital adrenal hyperplasia (CAD), hypopituitarism with corticotropin (ACTH) deficiency, and primary adrenal disorders. Primary adrenal insufficiency is commonly termed Addison disease; in adults, over 80% of Addison disease is due to autoimmune adrenalitis. The adrenal disorders of infants, children, and adolescents differ from those of adults and are shown in Table 534-2. Adrenal disorders are typically divided into chronic and acute causes, but many acute presentations reflect emergence of an undiagnosed underlying chronic or developmental process. Acute presentations may be triggered by intercurrent illness, trauma, or surgery, with poor fluid and sodium intake. A correct diagnosis facilitates long-term management and genetic counseling and assessing associated features.1-3

Table 534-2. Causes of Adrenal Insufficiency

Acute adrenal crisis commonly occurs in the child with undiagnosed chronic adrenal insufficiency at the time of additional stress (major illness, trauma, or surgery). The presenting symptoms and signs include abdominal pain, fever, hypoglycemia with seizures, weakness, apathy, nausea, vomiting, anorexia, hyponatremia, hypochloremia, acidemia, hyperkalemia, hypotension, shock, cardiovascular collapse, and death. Treatment requires fluid and electrolyte resuscitation, ample doses of glucocorticoids, chronic glucocorticoid and mineralocorticoid replacement, and treatment of the precipitating illness.


Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.