Adrenal gland and paraganglia
Adrenal insufficiency
Primary acute adrenal insufficiency - general

Topic Completed: 1 February 2005

Revised: 29 May 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Primary acute adrenal insufficiency

Nat Pernick, M.D.
Page views in 2018: 355
Page views in 2019 to date: 299
Table of Contents
Definition / general | Treatment
Cite this page: Pernick N. Primary acute adrenal insufficiency - general. website. Accessed December 14th, 2019.
Definition / general
  • Often insidious in onset, patients may present in shock due to increased stress
  • Patients usually live normal lives after diagnosis (depending on cause); may be at higher risk for heart failure, hypertension or osteopenia

    • Patients with chronic adrenal insufficiency (primary or secondary) and acute stress requiring immediate increase in steroids
    • Rapid withdrawal of exogenous steroids (i.e. no taper) or failure to increase steroids with acute stress
    • Massive adrenal hemorrhage destroying adrenal cortex due to anticoagulation, coagulopathy and newborns with physiologic deficiencies in prothrombin time
    • Hypotension / shock that causes mild or massive corticomedullary necrosis, including Waterhouse-Friderichsen syndrome
    • Infections that destroy substantial adrenal cortical tissue
    • Amyloidosis
    • Drugs, radiation
    • Autoimmune disorders (autoimmune adrenalitis or polyglandular autoimmune syndromes)
  • Glucocorticoids, mineralocorticoids and IV fluids
  • In chronic patients, must give steroid boost during infections, prior to surgery or during pregnancy
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