Adrenal insufficiency
Recognising chronic primary, secondary and glucocorticoid-induced adrenal insufficiency, confirming it with morning cortisol, ACTH and a short synacthen test, and getting hydrocortisone and fludrocortisone replacement right.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Chronic adrenal insufficiency is easy to miss: months of fatigue, weight loss, anorexia, nausea and postural dizziness, often labelled depression or gastroenteritis until a crisis.
- Glucocorticoid-induced suppression is by far the commonest cause. Of the rest, autoimmune Addison disease leads primary disease and pituitary tumours lead secondary disease.
- Test with an 8 to 9 am cortisol and ACTH, then a short synacthen test if the answer isn't clear.
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Sources
- Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guidelineEndocrine Society (Bornstein et al., J Clin Endocrinol Metab 2016;101:364-89), 2016
- European Society of Endocrinology and Endocrine Society joint clinical guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiencyESE and Endocrine Society (Beuschlein et al., J Clin Endocrinol Metab 2024), 2024
- Adrenal insufficiency: identification and management (NG243)National Institute for Health and Care Excellence, 2024
- Adrenal insufficiency resources (sick day management plan and steroid card)AU/NZEndocrine Society of Australia
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy