Chapter-063 Primary Adrenal Insufficiency

BOOK TITLE: ESI Manual of Clinical Endocrinology

1. Bhansali Anil
2. Gogate Yashpal
Publishing Year
Author Affiliations
1. Postgraduate Institute of Medical Education and Research, Chandigarh, India, Institute of Medical Education and Research, Chandigarh, India, P.G.I., Chandigarh, India, Post-Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, India, PGIMER, Chandigarh, India, Post Graduate Institute of Medical Education and Research, Chandigarh, India, ESICON–2014, PGIMER, Chandigarh, India, Postgraduate Institute of Medical, Education and Research, Chandigarh, India
2. Nashik, Maharashtra, India, Dr Vasantrao Pawar Medical College, Nashik; Harmony Health Hub, Nashik, Maharashtra, India, Harmony Health Hub, Nashik, Maharashtra, India
Chapter keywords
Adrenal insufficiency, mineralocorticoid deficiency, endocrine organ, acute adrenal crisis, relative lymphocytosis, mild metabolic acidosis, basal cortisol, adrenal imaging


Adrenal insufficiency is due to the deficiency in glucocorticoid with or without mineralocorticoid deficiency. It is the first clinical disorder that is linked unequivocally to pathologic changes in an endocrine organ. The etiology of primary adrenal insufficiency can be divided into congenital and acquired causes. Of them, acquired is most common. Usually the primary adrenal insufficiency patients have insidious onset of symptoms but only few patients have acute adrenal crisis and this can be treated by simply based on clinical suspicion. Normocytic normochromic anemia, relative lymphocytosis with an increased eosinophil count, and mild metabolic acidosis with mildly elevated blood urea concentration are the laboratory abnormalities that are associated with primary adrenal insufficiency. Brief description of basal cortisol and ACTH sample; ACTH stimulation test; prolonged ACTH stimulation test; immunology; mineralocorticoid status; adrenal imaging; treatment for acute adrenal crisis; patient education for long term therapy of primary adrenal insufficiency; and glucocorticoid, mineralocorticoid, and DHEA replacements are given in this chapter.

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