Insuficiencia suprarrenal

Abstract

Adrenal insufficiency (AI) is a low-incidence disorder with high comorbidity; it is the clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency also in adrenal androgens and/or mineralocorticoids, resulting from disease intrinsic to the adrenal cortex (primary AI), pituitary impairment (secondary AI) or hypothalamic disease (tertiary AI). Symptomatology varies widely depending on impairment level and deficit acuteness. Nevertheless, diagnosis requires a high suspicion level, depending entirely on the demonstration that hormonal secretion is inappropriately low using hormonal tests. Treatment goal is glucocorticoid and hormonal replacement avoiding deleterious effects caused by an excessive dosage. Hydrocortisone and fludrocortisone are the glucocorticoid and mineralocorticoid of choice, respectively. Hormone replacement screening is mainly clinical. Patients should be informed of dose adjustments in intercurrent situations. In adrenal crisis treatment has to be initiated as sooner as possible (intravenous glucocorticoid and electrolyte replacement).