title: Adrenal insufficiency.
abstract: Adrenal insufficiency is caused by either primary adrenal failure (mostly due to autoimmune adrenalitis) or by hypothalamic-pituitary impairment of the corticotropic axis (predominantly due to pituitary disease). It is a rare disease, but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia, and weight loss are non-specific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain, particularly in the identification of secondary adrenal insufficiency. Despite optimised life-saving glucocorticoid-replacement and mineralocorticoid-replacement therapy, health-related quality of life in adrenal insufficiency is more severely impaired than previously thought. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. Monitoring of glucocorticoid-replacement quality is hampered by lack of objective methods of assessment, and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist. However, all doctors should know how to diagnose and manage suspected acute adrenal failure.
authors.affiliation: Division of Medical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Arlt
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D011379:Prognosis; D011788:Quality of Life