Differentiating Secondary adrenal insufficiency from other diseases
Secondary adrenal insufficiency must be differentiated from primary adrenal insufficiency, acute adrenal insufficiency/adrenal crisis, adrenal hemorrhage, congenital adrenal hyperplasia and salt losing nephropathy based on clinical features, such as fatigue and weight loss and laboratory findings.
Secondary Adrenal Insufficiency
|Disease||Clinical history/findings||Causes||Laboratory findings||Medical therapy|
|Cortisol levels||Gold Standard||Other|
|Differentiating amongst adrenal insufficiencies|
|Chronic||Primary adrenal||+||+||+||+||+||+||+||Low||Cosyntropin/ ACTH stimulation test|
|±||–||+||+||–||±||–||Normal||Cosyntropin/ ACTH stimulation test||
|Acute||Acute adrenal insufficiency/ Acute adrenal crisis||++||±||+||+||+||±||+||"Normal to Low||"Cosyntropin/ ACTH stimulation test|
|Differentiating Adrenal Insufficiency from other diseases|
|Adrenal hemorrhage/ Waterhouse Friderichsen syndrome||Orthostatic||±||+||±||+||–||
||+||Normal to low||Cosyntropin/ ACTH stimulation test||
|Congenital adrenal hyperplasia (CAH)||Normal to hypertension||±
(can be indicator of Uncontrolled CAH)
||±||Low||Cosyntropin/ ACTH stimulation test||
|Syndrome of inappropriate antidiuretic hormone (SIADH)||–||–||–||–||–||–||+||Normal||Water deprivation test||
|Salt-depletion nephritis/ Salt losing nephropathy||+||–||–||–||+ Flank pain||–||++||High||Genetic study||<15:1 BUN:CR||
|Anorexia nervosa||+||–||+||+||–||+||–||High||Psychiatric condition||–|
Adrenal insufficiency must be differentiated from other causes of headache, polyuria and polydypsia.
|Disease||Causes||Symptoms||Diagnosis and treatment|
|SIADH||SIADH is a syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is hyponatremia, and sometimes fluid overload||
|Cerebral salt wasting syndrome||Cerebral salt wasting syndrome is defined as therenal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume||The patient is||Treatment is|
|Adrenal insufficiency||Adrenal insufficiency
Adrenal insufficiency can be
Common causes of primary adrenal insufficiency:
Chronic disease is characterized by
Acute addisonian crisis is characterized by:
|The diagnosis of Addisons disease is made through rapid ACTH administration and measurement of cortisol.
The definitive diagnosis is the cosyntropin or ACTH stimulation test. Acortisol level is obtained before and after administering ACTH. A normal person should show a brisk rise in cortisol level after ACTH administration.
|Hypopituitarism||Abnormality in anterior pituitary function
Etiology is as follows:
|Hypothyroidism||Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to autoimmune causes described below:||Diagnosis of hypothyroidism is based on blood tests:
|Psychogenic polydipsia||Also called as primary polydipsia is characterized bypolyuria and polydipsia. Causes are:||Evaluation ofpsychiatric patients with polydipsia requires an evaluation for other medical causes of polydipsia, polyuria,hyponatremia, and the syndrome of inappropriate secretion of antidiuretic hormone.
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