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

Author: Nat Pernick, M.D. (see Authors page)

Revised: 13 August 2018, last major update February 2005

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Primary acute adrenal insufficiency
Table of Contents
Definition / general | Treatment
Cite this page: Pernick, N. Primary acute adrenal insufficiency - general. website. Accessed December 14th, 2018.
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