During times of stress (e.g., illness, invasive surgical procedures), stress-dose glucocorticoids are required because destruction of the adrenal glands prevents an adequate physiologic response. Treatment of primary adrenal insufficiency requires replacement of mineralocorticoids and glucocorticoids. When clinically suspected, patients should undergo a cosyntropin stimulation test to confirm the diagnosis. Cortisol levels decrease and adrenocorticotropic hormone levels increase. The clinical manifestations before an adrenal crisis are subtle and can include hyperpigmentation, fatigue, anorexia, orthostasis, nausea, muscle and joint pain, and salt craving. In the United States and Western Europe, the estimated prevalence of Addison disease is one in 20,000 persons therefore, a high clinical suspicion is needed to avoid misdiagnosing a life-threatening adrenal crisis (i.e., shock, hypotension, and volume depletion). Autoimmune adrenalitis results from destruction of the adrenal cortex, which leads to deficiencies in glucocorticoids, mineralocorticoids, and adrenal androgens. Primary adrenal insufficiency, or Addison disease, has many causes, the most common of which is autoimmune adrenalitis.

Adrenal gland problems treatment