Adrenal insuficiency: Diagnosis and management

Abstract

Adrenal insufficiency is a disorder characterized by hypoactive adrenal glands resulting in insufficient production of the hormones cortisol and aldosterone by the adrenal cortex. This disorder may develop as a primary failure of the adrenal cortex or be secondary to an abnormality of the hypothalamic-pituitary axis. Patients with adrenal insufficiency often are asymptomatic or they may present with fatigue, muscle weakness, weight loss, low blood pressure, and sometimes darkening of the skin. The presentation of adrenal insufficiency varies dramatically and poses a major diagnostic dilemma. This review focuses on the diagnosis and treatment of primary and secondary adrenal insufficiency.

Sympathetic innervation controls homeostasis of neuromuscular junctions in health and disease

“…Recently, sympathicomimetics (SM) have been introduced successfully as clinical treatment of neuromuscular transmission disorders called congenital myasthenic syndromes (CMSs) (3,4). Fittingly, muscle weakness is a hallmark of several autonomous nervous system disorders, including chronic fatigue syndrome (5), congenital insensitivity to pain (6), adrenal insufficiency (7,8), complex regional pain syndromes (9,10), and Lambert-Eaton myasthenic syndrome (11)(12)(13). Because, furthermore, beta-blockers lead to increased susceptibility to muscle fatigue (14) and modulate neuromuscular activity of drugs applied during anesthesia (15), we became interested in addressing sympathetic innervation of skeletal muscle.…”

Adrenal insufficiency is prevalent in HbE/β‐thalassaemia paediatric patients irrespective of their clinical severity and transfusion requirement

“…Symptoms of adrenal insufficiency can vary greatly between patients, from asymptomatic to general malaise, chronic fatigue, gastrointestinal disturbances as well as muscle, abdominal and joint pain. 34 Even though HbE/b-thalassaemia children with adrenal insufficiency are often asymptomatic, it is important to identify these children as they may well require special care during acute illness so as to prevent acute adrenal crisis. Glucocorticoid supplementation should be given to these children when they develop fevers of ≥38Á5°C or during pre-and perioperative periods.…”

The sympathetic nervous system regulates skeletal muscle motor innervation and acetylcholine receptor stability

“…Autonomic nervous system failure is a manifestation of devastating acute and chronic diseases. Its functional impairment and resulting muscle weakness are conspicuous symptoms of Alzheimer's disease and such synucleinopathies as Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure . Muscle weakness associated with autonomic dysfunction is also obvious in adrenal insufficiency, Lambert‐Eaton myasthenic syndrome, and chronic fatigue syndrome .…”