Determining the etiology of primary adrenal insufficiency in adults

This algorithm reviews the approach to determining the etiology of primary adrenal insufficiency. It is based upon UpToDate content on diagnosis of adrenal insufficiency and causes of primary adrenal insufficiency.

PAI: primary adrenal insufficiency; 21-OH-Abs: 21-hydroxylase antibodies; VLCFA: very-long-chain fatty acids; ALD: adrenoleukodystrophy; CT: computed tomography.

* Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is not included in the algorithm, because it presents in infancy or childhood, not adulthood.

¶ The adrenocorticolytic drug mitotane causes PAI. Drugs that inhibit cortisol biosynthesis (ketoconazole and metyrapone) do not usually cause clinically important PAI unless the patient has limited pituitary or adrenal reserve.

Δ In adults with autoimmune primary adrenal insufficiency, thyroid disease and type 1 diabetes are the most likely endocrine disorders to also be present (as part of polyglandular autoimmune syndrome type II).

◊ To review the characteristic adrenal CT findings of these disorders, refer to UpToDate topic on causes of primary adrenal insufficiency.

Adapted from: Bornstein SR, Allolio B, Arlt W, Barthel A, et al. Diagnosis and treatment of primary adrenal insufficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2016; 101:364

Graphic 113308 Version 2.0

خرید پکیج

Determining the etiology of primary adrenal insufficiency in adults