Adrenal insufficiency: etiopathogeny and diagnostic aspects
Corina Crista1 & Corina Laura Niederl2
The diagnosis of the adrenal insufficiency requires complex clinical, laboratory and imagistic investigations. The study group was represented by 59 cases of adrenal insufficiency hospitalized in the Clinic of Endocrinology Timisoara, Romania, during the period 20002010 (age=42.10±16.30 years; F/M ratio=43/16). The patients were divided in two groups: primary adrenal insufficiency (42.37%) and secondary adrenal insufficiency (57.63%). In the group of primary adrenal insufficiency, the autoimmune Addisons disease represented 84% cases while the pituitary tumors had the highest incidence (44.12%) between the causes of the secondary adrenal insufficiency followed by Sheehans syndrome (29.41%). Forty-eight percent cases of autoimmune Addisons disease associated different autoimmune disorders, like: chronic autoimmune thyroiditis (66.67% cases), Graves disease (25% cases), gonadal failure, vitiligo, rheumatoid arthritis. Two patients with autoimmune Addisons disease presented subclinical adrenal insufficiency and were diagnosed by using tetracosactrin stimulation test. Only 6 cases of secondary adrenal insufficiency presented a normal rise of the cortisol serum levels at 2448 h after depot tetracosactrin administration. The patients with secondary adrenal insufficiency and associated central hypothyroidism presented a significant lower serum FT4 level than the patients with autoimmune Addisons disease associated with primary hypothyroidism (P<0.01).