DR Medhat MRCP

Adrenal insufficiency
Causes :
o Primary adrenal insufficiency :
سؤال 1) Autoimmune (= Addison`s disease) : the most common cause in UK
2) Antiphospholipid syndrome.
3) Infection :
- TB. - HIV
- Meningiococcal septicemia (Waterhouse-Friderichsen Syndrome).
- Sever sepsis (e.g in ICU septic patients).
4) Metastasis (e.g bronchogenic carcinoma),hemochromatosis , amyloidosis.
5) Drugs: ACE-I – Heparin – Lead poisoning- metyrabone-ketokonazole
6) Adrenoleukodystrophy (rare x-linked disorder).
7) Congenital adrenal hyperplasia (CAH).
o Secondary adrenal insufficiency :
1) Pituitary disorders (e.g. Tumours, Irradiation, Infiltration).
Addison`s disease
- i.e autoantibodies (e.g anti 21 hydroxylase ) that destroy the adrenal gland.
Clinical features :
سؤال هام فى االمتحان vomiting. o Typical history of Addison's: abdominal pain and
o Patients may have a history of other autoimmune conditions such as thyroid disorders.
o It`s unusal to find peaked T-waves in ECG (despite ↑ K + ) in hypoadrenalism,QRS
complexes are small & of low volume.
o Steroids should be given as soon as possible.