Adrenal insufficiency

Adrenal insufficiency refers to impaired secretion of cortisol with or without impaired secretion of aldo-sterone. Adrenal insufficiency can result from disorders of the adrenal cortex (primary adrenal insufficiency) or of the hypothalamus or pituitary (secondary adrenal insufficiency) (see Figure 19-2). Symptoms of adrenal insufficiency include weakness, abdominal pain, and hyperpigmentation. Chronic primary adrenal insufficiency, or Addison's disease, usually results from autoimmune adrenali-tis and can be treated with cortisol and aldosterone replacement.

Adults with Addison's disease exhibit an increased incidence of hospitalizations due to affective disorders, compared with the general population or adults with other serious diseases such as osteoarthritis (Thomsen et al. 2006). Additionally, case reports of psychosis associated with Addison's disease exist (Anglin et al. 2006). Men and women with Addison's disease treated with the weak adrenal androgen dehydroepiandrosterone report improved self-esteem, quality of life, and mood, as well as decreased fatigue (Gurnell et al. 2008; Hunt et al. 2000). Compared with Cushing's syndrome, far fewer studies of behavioral features associated with Addison's disease exist. Similar to Cushing's syndrome and diseases of the thyroid gland (congenital and acquired), most studies of Addison's disease that include cognitive or affective outcomes are performed exclusively in adults.

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