Primary adrenal insufficiency: The Daily PANCE Blueprint

The answer is d. Fatigue, hyponatremia, hyperpigmentation

Adrenal insufficiency is defined by insufficient production of hormones by the adrenal glands. Remember the MOST common cause of adrenal insufficiency overall is sudden withdrawal of exogenous steroids. The most common primary cause of adrenal insufficiency is autoimmune adrenalitis (aka Addison disease aka 21-hydroxylase antibodies against the adrenal gland). Patients will have symptoms and signs of glucocorticoid & mineralocorticoid deficiency, such as fatigue (MC), weight loss, nausea, vomiting, hyponatremia, hyperkalemia, skin hyperpigmentation (due to increased production of proopiomelanocortin prohormone), hypotension, and salt craving. Remember secondary adrenal insufficiency does NOT lead to hyperpigmentation, only primary adrenal insufficiency (this is commonly asked in tests). Diagnosis of adrenal insufficiency is made by serum cortisol level and then a cosyntropin stimulation test. Treatment is glucocorticoids +/- mineralocorticoids.