Secondary adrenal insufficiency: recent updates and new directions for diagnosis and management

  • Lucinda M. Gruber
    Affiliations
    Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
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  • Irina Bancos
    Correspondence
    Corresponding Author: Irina Bancos Mayo Clinic - Division of Endocrinology, Diabetes, Metabolism and Nutrition 200 First St SW, Rochester, MN 55901 Phone: (507)284-2617 Fax: (507)284-8745
    Affiliations
    Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN

    Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
    Search for articles by this author
Published:October 01, 2021DOI:https://doi.org/10.1016/j.eprac.2021.09.011

      Highlights

      • Secondary adrenal insufficiency is caused by the disruption of the pituitary function due to medications, pituitary tumors, infiltrative, and rarely genetic disorders.
      • Diagnosis of secondary adrenal insufficiency can be challenging and requires understanding of the clinical context and biochemical assessment of the hypothalamic-pituitary-adrenal axis.
      • Management of secondary adrenal insufficiency aims to deliver a close to physiological daily glucocorticoid replacement and appropriate therapy during sickness.
      • Patient education is key to assure good outcomes.

      Abstract

      Secondary adrenal insufficiency is the most common subtype of adrenal insufficiency that can be caused by certain medications, pituitary destruction (as in pituitary masses, inflammation, or infiltration), or, rarely, associated with certain germline variants. In this review, we discuss the etiology, epidemiology, and clinical presentation of secondary adrenal insufficiency, and focus on the diagnostic and management challenges. We also review management of selected special populations of patients and discuss patient-important outcomes associated with secondary adrenal insufficiency.

      Key Words

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