Steps of laboratory evaluation
1.Exclude exogenous GC intake
2.Laboratory confirmation of endogenous cortisol overproduction: - Detection of free cortisol in saliva
- Dexamethasone supression test
- Detection of free cortisol in 24-h urine
- Evaluation of serum cortisol in the evening - 48-h dexamethasone test
3.Distinguishing between ACTH-dependent and ACTH-independent endogenous hypercorticism
4.Distinguishing between Cushing`s disease and ACTH-ectopic syndrome
Imaging. Pituitary gland
Micro- and macroadenoma
Imaging. Adrenal glands
(А)- Bilateral adrenal hyperplasia
(Б)- Solitary adenoma of the left adrenal gland
(С)- Multinodular hyperplasia
(D)- Primary pigmented adrenal gland disease
Adrenal adenocarcinoma with metastases in the liver
Treatment
Medical therapy |
Surgery |
• |
Transsphenoidal adenomectomy |
• |
Adrenal surgery |
Irradiation
• Pituitary radiotherapy
Endocr Rev. 2015; 36(4): 385–486
Adrenal insufficiency
A disease characterized by a deficient production or action of glucocorticoids with or without deficiency in mineralocorticoids and/or adrenal androgens
Signs and symptoms of adrenal insufficiency
Glucocorticoid deficiency
•Fatigue, lack of energy
•Weight loss, anorexia
•Myalgia, joint pain
•Fever
•Anemia, lymphocytosis, eosinophilia
•Hypoglycemia
•Low BP, postural hypotension
•Hyponatriemia
Mineralocorticoid deficiency
•Abdominal pain, nausea, vomiting
•Dizziness, postural hypotension
•Salt craving
•Low BP
•Hypovolemia
•Hyperkalemia, hyponatriemia
Adrenal androgen deficiency
•Lack of energy
•Dry itchy skin in women
•Loss of libido in women
•Loss of axillary and pubic hair
Other signs
• Hyperpigmentation (only in primary AI)
Diagnostic evaluation
•Normochromic/hypochromic anemia, slight leukopenia
•Hyponatriemia, hypochloremia, hyperkalemia
•Low 24-h urine cortisol
•Tests with ACTH
•Adrenal imaging (US, CT, MRI)
•MRI of the brain
Treatment of chronic adrenal insufficiency
Daily hormonal replacement:
1.Mineralocorticoids: Fludrocortisone
2.Glucocorticoids: hydrocortisone, prednisone