The most common cause of hypoadrenalism is Addisons, which describes the autoimmune destruction of the adrenal glands.
Causes may be divided into primary and secondary.
The problem is with the adrenal glands.
The adrenals are fine, but there is a problem upstream in the hypothalamic-pituitary-end-organ axis.
Addison's disease describes the autoimmune destruction of the adrenal glands
Screening: 9 am serum cortisol
Definitive diagnosis: ACTH stimulation test (short Synacthen).
Antibody testing can also be done, e.g, anti-21-hydroxylase.
The endocrine society recommends measuring renin and aldosterone levels as part of the work up.
Patients will require glucocorticoid and mineralocorticoid replacement therapy.
Important to tell the patient not to miss a dose, and explain sick day rules:
The endocrine society recommends that patients should be monitored by testing blood electrolyte levels and checking for symptoms like salt craving, light-headedness, blood pressure changes and swelling of the legs and feet.
This is where the demand of cortisol suddenly is increased for one reason or the other and there is not adequate supply.