P1: SBT
0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18
Adrenal Insufficiency 67➣Retroperitoneal hemorrhage
➣Anticoagulation, antiphospholipid syndrome, thromboembolic
disease
➣Sepsis (eg, meningococcus, pseudomonas), severe stress
➣Postoperative (esp. cardiac surgery)
➣Anemia, hyponatremia, hyperkalemia
➣Pituitary apoplexy
➣Acute headache, visual field deficit, 3–6 cranial neuropathies
■Chronic AI:
➣Weight loss, nausea/vomiting
➣TB, fungal infections, fever
➣Autoimmune disorders, HIV/AIDS, progestational agents
➣Past, recent, or current glucocorticoid administration
➣Cutaneous/buccal pigmentation, vitiligo
➣Salt craving, hypotension, orthostatic hypotension
➣Family history endocrine deficiencies
➣Electrolyte abnormalities
➣Enlarged or calcified adrenals
➣Coagulopathy, anticoagulants
➣Pituitary tumor, visual field abnormalities, galactorrhea
➣Infiltrative disorders (eg, hemochromatosis, amyloidosis, sar-
coidosis)
➣Malignancy: cigarette smoking, weight loss, bone or abdominal
painSigns & Symptoms
■Weight loss, decreased appetite, fatigue
■Salt craving
■Orthostatic dizziness
■Hyperpigmentation: cutaneous hyperpigmentation, buccal hyper-
pigmentation, calcified ears
■Decreased libido
■Hypotension, orthostatic hypotension
■Decreased axillary and pubic hair
tests
Laboratory
■Basic blood studies:
➣Hyponatremia, eosinophilia, lymphocytosis, hypercalcemia (mild)
➣Primary AI only: hyperkalemia, metabolic acidosis, azotemia
➣Low cortisol (<7 mcg/dL) with high ACTH (>50 pg/mL) at 8 AM
in Primary AI