Adrenal Anatomy:

Primary Adrenal Failure (Addison’s Disease):

• Failure of the adrenal cortex
• Prevalence 10-15/100,000 persons
• Etiology – Autoimmune adenitis ~70-80%; 2/3 will have at least one other autoimmune endocrine disorder; TB infiltration ~ 7-20%

Diagnostic Algorithm:

Adrenocorticotropic Hormone Deficiency (secondary cortisol deficiency):

Etiology:

1. Exogenous glucocorticoid use
2. Damage to the pituitary gland/stock

• Reminder of intact adrenal cortex will be a normal renin/aldosterone ratio
• Less risk for hypotension, hyponatremi, adrenal crisis than primary failure
• No hyperpigementation due to lack of hypersecrtion of ACTH

Multiple case reports of megase induced secondary adrenal insufficency