Endocrine Abstracts

Adrenal insufficiency represents a sign and symptom of an underlying specific condition. A key diagnostic question is the differentiation between primary and secondary/ tertiary adrenal insufficiency (AI) to define the aetiology and manage the patient appropriately. The most common cause for primary adrenal insufficiency is congenital adrenal hyperplasia (CAH) representing a group of autosomal recessive conditions leading to glucocorticoid deficiency and other steroid hormone imbalances. The most common cause for secondary/tertiary AI is the iatrogenic use of glucocorticoids suppressing the hypothalamic–pituitary–adrenal (HPA) axis. The majority of the other forms of primary and secondary adrenal insufficiency are rare conditions. It is critical to establish the underlying aetiology of each specific condition as a wide range of additional health problems specific to the underlying disorder can be found. In recent years, several novel conditions leading to AI caused by deficient pathways and mechanism other than classic endocrine pathways have been described. After establishing the correct differential diagnosis, adequate replacement with steroid hormones during normal life and stress is essential to avoid under- and over-treatment, which can cause significant future health problems. This presentation will provide an overview on the diagnostic approach to adrenal insufficiency, an update on the differential diagnosis and treatment of patients with adrenal insufficiency.