- Glucocorticoids (cortisol) from zone fasciculate (Under Hypothalamus/Pitiutary control)
- Mineralocorticoids (aldosterone) from zona glomerulosa (Under control of RAAS)
- Gonadocorticoids (sex hormones) from zone reticular (Under Hypothalamus/Pitiutary control)
- Catecholamines (adrenaline, noradrenaline and dopamine) from adrenal medulla
Secondary adrenal insufficiency presents with symptoms of diminished cortisol (weight loss, lethargy, weakness, confusion, anorexia, GI distress, abdominal pain). Typically secondary AI presents as Hypoglycemia, Hypo/HyperNa, Hypokalemia, Hypotension.
- IV Fluid Resuscitation (May need dextrose if hypoglycaemic)
- IV Steroids once circulation is filled (Hydrocortisone 100mg IV)
- Manage Electrolytes (HyperK, Hypo/HyperNa)
- Find and treat the underlying ethology
- Consider adrenal crisis in situations of unexplained hypotension, especially in patients with a history of glucocorticoid therapy.
- For a minor illness or injury, triple the daily glucocorticoid dose for 24 to 48 hours until symptoms improve.