A GP guide to adult adrenal insufficiency

Need to know:

• Primary adrenal insufficiency (Addison’s disease) is characterised by the lifelong requirement for both glucocorticoid and mineralocorticoid therapy.
• Secondary adrenal insufficiency is a result of impairment of the hypothalamic–pituitary–adrenal axis. This is most commonly due to suppression by exogenous glucocorticoid administration but may also be due to tumour, surgery, radiotherapy and infiltrative or inflammatory disorders. Glucocorticoid replacement is required.
• Oral glucocorticoid replacement options include cortisone acetate, hydrocortisone  and prednisone. Dexamethasone is usually avoided as replacement therapy.
• Adrenal crisis is a life-threatening emergency. Patients, family members and treating doctors must be aware of the requirement for stress-cover glucocorticoid replacement in the event of acute illness. A written ‘sick day management’ plan should be readily available, and the patient should wear