Chronic adrenal insufficiency in clinical practice

Aim. To present causes, pathogenesis, clinical presentation, diagnostics and treatment of chronic adrenal insufficiency. Materials and methods. Data from 23 scientific sources published in Russia and abroad in years 1985-2017 are presented. Results. Although adrenal insufficiency is a rare endocrine system disorder, early diagnostics and treatment of adrenal insufficiency (AI) is of great importance in clinical practice because this is a life-threatening disorder when not treated. Depending on the level of hypothalamic-pituitary-adrenal system damage, primary (PAI), secondary (SAI) and tertiary adrenal insufficiency are distinguished. The main cause of PAI (80-90%) is an autoimmune destruction of adrenal cortex (autoimmune adrenalitis): isolated damage or a part of autoimmune polyglandular syndrome. Adrenal glands damage can also develop as a result of various factors: infections (tuberculosis, fungous and cytomegalovirus infections), tumors (malignant tumors or metastases), adrenalectomy, and adrenoleukodystrophy. The most frequent cause of SAI is glucocorticoids therapy in pharmacological doses, timorous and destructive processes in pituitary-hypothalamic area that result in ACTH production decrease and suppression. Clinical presentation is not a highly specific criterion of CAI diagnostics and requires confirmation with laboratory results. AI clinical manifestations aggravate in association with stressful situations, intercurrent diseases, high fever, and surgical interventions. A patient with chronic primary adrenal insufficiency needs constant replacement therapy with glucocorticoids and, in most cases with mineralocorticoids. Conclusion. Awareness of AI clinical presentation and modern diagnostic methods will allow diagnosing the disease on time and prescribing replacement therapy.

chronic adrenal insufficiency, autoimmune destruction of adrenal cortex, hyponatremia, replacement therapy, hydrocortisone