![]() Patients with primary adrenal insufficiency tend to additionally develop hyperpigmentation of the skin, mild hyperkalemia, and metabolic acidosis. There may also be a loss of libido as a result of hypoandrogenism. Patients with long-standing adrenal insufficiency can present with postural hypotension, nausea, vomiting, weight loss, anorexia, lethargy, depression, and/or chronic hyponatremia. Decreased levels of ACTH or CRH are seen following sudden cessation of prolonged glucocorticoid therapy and in pituitary/ hypothalamic diseases. Secondary adrenal insufficiency is the result of decreased production of ACTH ( adrenocorticotropic hormone) and tertiary adrenal insufficiency is the result of decreased production of CRH ( corticotropin-releasing hormone) by the hypothalamus. The most frequent cause of primary adrenal insufficiency in the US by far is autoimmune adrenalitis, which can occur sporadically or as a manifestation of polyglandular autoimmune syndromes. Primary adrenal insufficiency ( Addison disease) is caused by a disorder of the adrenal glands. ![]() Adrenal insufficiency is the decreased production of adrenocortical hormones ( glucocorticoids, mineralocorticoids, and adrenal androgens) and is classified as primary, secondary, or tertiary.
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