Glucocorticoid (± mineralocorticoid) deficiency — primary (adrenal) or secondary (pituitary).
Causes
- • Autoimmune (Addison)
- • TB, fungal, HIV
- • Adrenal haemorrhage (Waterhouse-Friderichsen)
- • Iatrogenic: long-term steroids → withdrawal
- • Hypopituitarism
Clinical features
- • Fatigue, weight loss, anorexia
- • Postural hypotension, salt craving
- • Hyperpigmentation (primary)
- • Crisis: hypotension, shock, hypoglycaemia, hyperkalaemia
Investigations
- • 9 am cortisol, ACTH
- • Short Synacthen test (cortisol <500 nmol/L at 30 min = abnormal)
- • U&E, glucose, adrenal autoantibodies, imaging if secondary
Management
- • Crisis: hydrocortisone 100 mg IV stat then 50 mg q6h + IV fluids + glucose; treat precipitant
- • Maintenance: hydrocortisone 15–25 mg/day in divided doses + fludrocortisone 50–200 mcg OD
Clinical pearls
- • Double steroid dose during illness (sick-day rules); IM hydrocortisone kit for emergencies
References
- • Endocrine Society 2016
Educational — verify locally.
