Key concepts

Signs and symptoms of adrenal insufficiency reflect the disturbance of normal physiologic carbohydrate, fat, and protein homeostasis caused by inadequate cortisol production and inadequate cortisol action.

Lifelong glucocorticoid replacement therapy may be necessary for patients with adrenal insufficiency, and mineralocorticoid replacement therapy is usually required for those with Addison's disease.

During an acute adrenal crisis, the immediate treatment goals are to correct volume depletion, manage hypoglycemia, and provide glucocorticoid replacement.

O1 Patients with known adrenal insufficiency should be educated regarding the need for additional glucocorticoid replacement and prompt medical attention during periods of excessive physiologic stress.

© Patients with Cushing's syndrome due to endogenous or exogenous glucocorticoid excess typically present with similar clinical manifestations.

© Surgical resection is considered the treatment of choice for Cushing's syndrome from endogenous causes if the tumor can be localized and if there are no contraindications.

Pharmacotherapy is generally reserved for patients: (a) in whom the ectopic adrenocorticotropic hormone (ACTH)-secreting tumor cannot be localized, (b) who are not surgical candidates, (c) who have failed surgery, (d) who have had a relapse after surgery, or (e) in whom adjunctive therapy is required to achieve complete remission.

® In drug-induced Cushing's syndrome, discontinuation of the offending agent is the best management option. However, abrupt withdrawal of the glucocorticoid can result in adrenal insufficiency or exacerbation of the underlying disease.

O Glucocorticoid doses less than 7.5 mg/day of prednisone or its equivalent for less than 3 weeks generally would not be expected to lead to suppression of the hypo-thalamic-pituitary-adrenal (HPA) axis.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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