Patient Education - Endocrine Encyclopedia
Endocrine Surgery Encyclopedia
Definition:
Exogenous adrenal insufficiency is a condition of low levels of hormones released
by the adrenal glands, caused by factors other than problems with the glands themselves.
See Addison's disease for information on adrenal deficiency caused by problems within
these glands.
Alternative Names: Drug-induced adrenal insufficiency
Causes, incidence, and risk factors:
Glucocorticoids such as prednisone, hydrocortisone, and dexamethasone are similar
to natural hormones produced by the adrenal glands. They are used to treat a variety
of conditions including many inflammatory diseases such as asthma and some forms
of arthritis.
When people are treated with glucocorticoids, the production of adrenal hormones
may decrease because of effects on the pituitary, the master gland that controls
the adrenals.
If glucocorticoids are stopped or decreased too quickly, the adrenal glands may
not begin making their own hormones again fast enough to meet the body's needs, and
symptoms of adrenal insufficiency result. This condition usually occurs when these
drugs are given systemically (by pills or injections), rather than topically (on
the skin) or in inhaled forms. Higher doses and longer treatment increase the risk.
Abrupt cessation of treatment with glucocorticoids is the most common cause of
adrenal insufficiency.
Other drugs that may cause adrenal insufficiency include the following:
- Megestrol
- Ketoconazole
- Metyrapone
- Aminoglutethimide
- Mitotane
These drugs have direct effects on the adrenal glands, decreasing glucocorticoid
production. Symptoms:
Symptoms may include:
- Weakness
- Lethargy, fatigue
- Nausea and vomiting
- Arthralgias, myalgias (muscle pains)
- Low blood pressure (hypotension) that may cause light-headedness or fainting
when the affected person stands after sitting or lying down
- Shock
Signs and tests:
Typically, a patient who has been taking steroids and has developed this condition
will exhibit features similar to Cushing's syndrome (round face, obesity around the
waist, abdominal striae), while having symptoms of adrenal insufficiency.
Tests will look for:
- Low cortisol level
- Low sodium
- Hypoglycemia
- Depressed response to ACTH
Treatment:
Treatment consists of administration of additional glucocorticoids. Higher doses
are needed in stressful situations (such as during infections or prior to and after
surgery).
Support Groups:
Expectations (prognosis):
Patients usually respond to administration of glucocorticoids. Long-term prognosis
depends on the degree of dependence on these drugs and any resulting complications.
If glucocorticoids treatment is no longer needed for the original condition for which
they were initially prescribed, the drugs can be very slowly tapered under the supervision
of a physician.
The length of the taper can extend over many months, and some level of withdrawal
symptoms is likely.
Complications:
Complications include ongoing steroid dependence and need for stress-situation steroids
for an indeterminate length of time. Complications related to steroid use, such as
diabetes, high blood pressure, and osteoporosis, may also occur.
Serious complications include adrenal crisis, which requires immediate administration
of glucocorticoids. Symptoms include dizziness, nausea and vomiting, and extreme
fatigue, which usually follows a stress on the body such as dehydration, infection,
or another illness or injury. Adrenal crisis can generally be prevented by increasing
(doubling or tripling) the steroid dose during illness or other physical stress.
Calling your health care provider:
Call your health care provider if you are taking glucocorticoid drugs and experience
any of the symptoms of adrenal insufficiency. If the symptoms are severe, go to the
emergency room or call 911.
People with adrenal insufficiency should wear a Medic-Alert tag to alert health
care professionals to this condition in case of emergency.
Prevention:
Minimizing duration and dose of glucocorticoids, use of alternate-day steroids, and
use of steroid-sparing agents (for treatment of asthma or arthritis, for example)
may help minimize development of exogenous adrenal insufficiency.
Review Date: 8/6/2004
Reviewed By: Aniket R. Sidhaye, M.D., Division of Endocrinology and Metabolism, Johns
Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed
Healthcare Network.
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