Adrenal insufficiency

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Adrenal insufficiency is defined as a group of "conditions in which the production of adrenal corticosteroids falls below the requirement of the body. Adrenal insufficiency can be caused by defects in the adrenal glands, the pituitary gland, or the hypothalamus."[1]


The following classification is from Robbins and Cotran.[2]

Primary insufficiency

Loss of cortex
  • Congenital adrenal hypoplasia
  • Autoimmune adrenal insufficiency
  • Infection (including Waterhouse-Friderichsen syndrome)
Metabolic failure of hormone production
  • Congenital adrenal hyperplasia
  • Drug and steroid-induced inhibition

Secondary insufficiency

Hypothalamic pituitary disease
Hypothalamic pituitary suppression


The following is from a systematic review:[3]

Accuracy of the cosyntropin stimulation test.
Setting sensitivity specificity
Primary adrenal insufficiency
(250-µg cosyntropin test)
97% 95%
Secondary adrenal insufficiency
(250-µg cosyntropin test)
57% 95%
Secondary adrenal insufficiency
(1-µg cosyntropin test)
61% 95%
1. An abnormal test is a cortisol level < 415 nmol/L 30-60 minutes after injection of cosyntropin. However, if secondary adrenal insufficiency is a consideration, then a cutoff of 500 to 600 nmol/L is needed for adequate sensitivity.
2. A basal cortisol level is not usually needed.


  1. Anonymous. Adrenal insufficiency 1214-1217. National Library of Medicine. Retrieved on 2008-01-16.
  2. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. ISBN 0-7216-0187-1. 
  3. Dorin RI, Qualls CR, Crapo LM (2003). "Diagnosis of adrenal insufficiency". Ann. Intern. Med. 139 (3): 194–204. PMID 12899587[e]