Snapshot A 15-year-old man is brought to his pediatrician by his father for complaints of fatigue, weight loss, and recurrent episodes of nausea and vomiting. His symptoms have been occurring for more than 2 weeks and he can’t recall any clear precipitating factors. He denies fever, symptoms of upper respiratory infection, chest pain, palpitations, abdominal pain, or urinary symptoms. A physical examination demonstrates hyperpigmentation of his oral mucosa. A basic metabolic panel reveals hyponatremia and hyperkalemia. Introduction Clinical definition disorder characterized by the loss of adrenal gland function leading to the deficiency of aldosterone (mineralcorticoids) and cortisol can be either acute or chronic depending of the etiology Associated conditions approximately ½ of patients with autoimmune adrenal insufficiency have other autoimmune endocrine disorders (e.g., hypothyroidism) Epidemiology Demographics autoimmune causes (which accounts for 70-90% of cases in the U.S.) occur predominantly within the female population Risk factors other autoimmune endocrinopathies ETIOLOGY Pathogenesis any process that damages the adrenal cortices and leading to a deficiency of aldosterone and cortisol autoimmune adrenalitis (Addison disease) login to view 3 more bullets infectious adrenalitis login to view 3 more bullets hemorrhagic infarction login to view 2 more bullets metastatic disease login to view 1 more bullet Presentation Symptoms fatigue weight loss nausea/vomiting abdominal pain muscle/joint pain salt craving adrenal crisis Physical exam skin and mucosal hyperpigmentation (if longstanding) login to view 1 more bullet hypotension auricular-cartilage calcification vitiligo Studies Diagnostic testing diagnostic approach login to view 2 more bullets imaging login to view 2 more bullets studies login to view 15 more bullets Differential Secondary adrenal insufficiency distinguishing factors login to view 2 more bullets Treatment First-line glucocorticoid replacement therapy login to view 3 more bullets mineralcorticoid replacement therapy login to view 2 more bullets androgen replacement therapy login to view 3 more bullets Complications Adrenal crisis medical emergency managed with schedule IV glucocorticoid