Talk:Adrenal insufficiency

Congenital Adrenal Hyperplasia

Congenital Adrenal Hyperplasia is th primary cause of Adrenal Insufficiency. Stop deleting links when you haven't a clue about the subject!! I have two kids with CAH and people will come here looking for info about it. Dannycarlton 23:32, 6 June 2006 (UTC)

As I explained on my talkpage in response to your message, the link belongs on congenital adrenal hyperplasia. I do have a clue about the subject. The vast minority of people with adrenal insufficiency have CAH. JFW | T@lk 23:49, 6 June 2006 (UTC)

From eMedicine "Primary adrenocortical insufficiency is an uncommon disorder with an incidence in Western populations near 50 cases per 1,000,000 persons." Since, in the general population about one person in 50 carries the CAH gene (trait). That would make the instance of CAH one in every 2,500. It's actually a bit more rare than that, but obviously the figures account for quite a significant number of those with Adrenal Insufficieny. Dannycarlton 00:06, 7 June 2006 (UTC)

Danny: the link belongs on the CAH page. Most adrenal insufficiency is caused by steroid therapy and autoimmune causes. Have you reviewed our external links policy yet? JFW | T@lk 00:12, 7 June 2006 (UTC)

Please refrain from editing topics that you know so little about. You are one of the reasons Wikipedia has such a horrible reputation. I have been deeply involved in CAH for over 12 years now, and you apparently looked it up once. Stop turning WP into your personal site and let people offer information when they know the topic. Dannycarlton 02:05, 7 June 2006 (UTC)

DNFTT. JFW | T@lk 02:16, 7 June 2006 (UTC)

I've been involved in helping people with Addison's, primary and secondary adrenal insufficiency for years, dealt with at least 3000 people in that time and have run across CAH no more than half dozen times.Chrisgj (talk) 03:43, 25 August 2008 (UTC)

Waterhouse-Friderichsen syndrome?

This entry lists Waterhouse-Friderichsen syndrome as an adrenal insufficiency condition, but the page of that syndrome says that "It is sometimes said that the hemorrhage in Waterhouse-Friderichsen syndrome causes an acute adrenal insufficiency, but this is inaccurate, since blood cortisol levels are not decreased. The shock, purpura and intravascular clotting are probably the result of an endotoxin mediated immune reaction caused by sepsis." so it seems like there's a contradiction. DiamonDie 11:32, 30 August 2006 (UTC)

In every source I've seen, not one has mentioned sepsis as probable. Neither have I found anything to suggest that cortisol levels are normal in cases Waterhouse-Friderichsen syndrome In fact, it is likely that this statement is entirely speculative. I can find no sources to back up the statement. I have suggested editing the article on Waterhouse-Friderichsen syndrome. From [1]: "24 patients (among 35 clinical cases) with meningococcal Waterhouse-Friderichsen syndrome were submitted to pathologic anatomical examinations (including 18 microscopic investigations). Two aspects were found: 12 cases of mild suprarenal hemorrhage (histological evidence only), but associated with massive degeneration of the adrenocortical cells, leptomeningitis, distinct thymic hypertrophy with microthrombi in various organs. The other 12 cases presented massive bilateral suprarenal hemorrhage with medium status thymo-lymphaticus and distinct capillary thromboses in all organs investigated (consumptive coagulopathy)."

Tiny.ian 00:38, 16 September 2006 (UTC)

I'm adopting this article

I noticed this article was started 4 years ago, but hasn't had any real attention. Hadn't not changed hardly, stayed a stub for 4 years. I'm finishing with ACTH stimulation test which I started and been working on for 6 months and about to call it all done. Submitting reassessment of grade Sept 1st, then I will focus all my attention on this article which I've worked on some the last two nights and will work on for the next few months. This article I will devote to the same as I did ACTH stimulation test.Chrisgj (talk) 01:54, 22 August 2008 (UTC)

I found several problems with the previous version, but really tried to keep as many bits of the original as I could which unfortunately isn't that much.Chrisgj (talk) 03:10, 26 August 2008 (UTC)

Possible source

ISBN 9780198570158 (medical textbook) is available at books.google.com, and chapter 12.7 is entirely about adrenal problems. I think that it could be a useful citation for many currently unsupported statements in this article. WhatamIdoing (talk) 18:06, 8 September 2008 (UTC)

Problems with "Simple Diagnosis Chart" Section

I noticed a problem with the "simple diagnostic table": there seems to be some disagreement among various sources about whether or not aldosterone levels are affected (i.e. decreased) during secondary adrenal insufficiency.

Aldosterone NOT Affected	Aldosterone Affected	Equivocal
This source (cited in the article) states: "This form of Addisons [sic] disease [secondary AI] can be traced to a lack of ACTH, which causes a drop in the adrenal glands [sic] production of cortisol but not aldosterone." "With secondary adrenal insufficiency, aldosterone production is usually not affected." --LabTestsOnline "Because the adrenal hormone aldosterone is not primarily regulated by pituitary ACTH, patients with secondary adrenal insufficiency continue to produce aldosterone." --Adrenal Insufficiency, Pejman Cohan, M.D. and Anne Peters, M.D. "An additional feature distinguishing primary adrenocortical insufficiency is the near-normal level of aldosterone secretion seen in pituitary and/or isolated ACTH deficiencies." --Harrison's Endocrinology	McPhee et al. write: "No matter what the origin, the clinical manifestations of adrenocortical insufficiency are a consequence of deficiencies of cortisol, aldosterone, and (in women) androgenic steroids." --Pathophysiology of Disease: an Introduction to Clinical Medicine, 4th ed., p. 597; Lange, 2003	"In secondary adrenal insufficiency, baseline aldosterone levels may be low or normal...." --Manual of Endocrinology and Metabolism, by Norman Lavin

I think the value for aldosterone for secondary AI should be changed to "normal." Also, perhaps this table could use some more scrutiny. —Preceding unsigned comment added by Dwstultz (talk • contribs) 16:47, 17 May 2011 (UTC)

A suggestion: the intent of most of the table is far from clear. An umbrella heading over columns CRH to K, such as "possible pathologies", could fix that.

And a query: the meaning that I understand the phrase "exogenous steroid use" to intend to convey is use of exogenous corticosteroids. Would there be any disagreement with that? Thanks…

Signatorius (talk) 12:35, 17 March 2013 (UTC)

Medical legitimacy of adrenal fatigue / hypoadrenia?

The "See also" section contained the following entry for adrenal fatigue, which seems to misleadingly suggest an air of medical legitimacy which the article itself does not:

• Hypoadrenia (adrenal fatigue), the precursor to adrenal insufficiency.

I replaced it with the following, based on the adrenal fatigue article's text:

• Adrenal fatigue (hypoadrenia), a term used in alternative medicine to describe a believed exhaustion of the adrenal glands

--Piet Delport (talk) 23:38, 12 April 2012 (UTC)

Treatment in case of exogenous steroid use

Can someone add the recommended treatment in the relevant section, in case the adrenal insufficiency is caused by exogenous steroid use? Is it simply a matter of tapering off the medication and waiting for endogenous function to return to normal, or is there something else that can be done in addition to speed up endogenous production recovery?

62.195.45.181 (talk) 19:33, 17 January 2014 (UTC)

"ADH" Disambiguation

This page was identified as including a disambiguation error based on the term "ADH".

In order to resolve this problem I have removed the wikilink from the term as I am unable to determine, from the context, what it is referring to. If you wish to restore the link please ensure that the term and the link are fully resolved so that no further disambiguation occurs. Perry Middlemiss (talk) 06:23, 22 January 2015 (UTC)

 Done BakerStMD T|C 15:28, 22 January 2015 (UTC)

Many thanks. Perry Middlemiss (talk) 19:24, 22 January 2015 (UTC)

Corticosteroids

Hypoadrenalism is common, can be caused by any dose/duration (but more likely in higher/longer courses) and the threshold for testing should be low. doi:10.1210/jc.2015-1218 JFW | T@lk 09:12, 8 June 2015 (UTC)

Endocrine society guideline

... for primary hypoadrenalism doi:10.1210/jc.2015-1710 JFW | T@lk 15:39, 18 January 2016 (UTC)

Wiki Education assignment: WikiProject Medicine Fall 2022 UCF COM

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 October 2022 and 18 November 2022. Further details are available on the course page. Student editor(s): Oddcomb (article contribs). Peer reviewers: Nobajoe.

— Assignment last updated by DrDexterN (talk) 20:34, 14 November 2022 (UTC)

Hello, I am a 4th year medical student, and I am participating in a WikiProject course. I have selected this article to work on and improve, seeing as there are several instances which require citations, and some causes of adrenal insufficiency that are not included.

I plan to add information from the following sources:

Opioids and Their Endocrine Effects: A Systematic Review and Meta-analysis https://pubmed.ncbi.nlm.nih.gov/31511863/

Is peri-operative steroid replacement therapy necessary for the pituitary adenomas treated with surgery? A systematic review and meta analysis https://pubmed.ncbi.nlm.nih.gov/25775019/

I also plan to find more established sources such as textbooks to further elucidate the pathophysiology of adrenal insufficiency.

Please let me know if there is anything else I can include!

Oddcomb (talk) 01:40, 27 October 2022 (UTC)

Hello, here are some possible edits

Before anything else, I do just want to say I think you should consider the audience. There will be a lot of patients and family members coming to this page, so check over your writing and make sure it is accessible. There were a few instances I came across that struck me as being more geared towards the medical community. For example, "basal morning serum cortisol concentration" could be "baseline morning cortisol level in the blood". Another example is the first sentence under "cortisol deficiency" where you mention things like lipolysis and proteolysis where you could instead say something like "causes the body to use fat stores and muscle for energy." You can still link to the lipolysis and proteolysis articles for those who want more of an explanation, but the blue text itself as it appears in this article should be more geared towards a layman. So I just encourage you to read through everything and make sure most of it could be understood by your patients if you gave them the link to this article during rounds.

From Peer Review Checklist:

- Yes, the article is very relevant to the topic

- Yes, the article is neutral. Fortunately not the most controversial topic unless you want to discuss Chronic Fatigue Syndrome, but I don't blame you for not going there

- Yes, viewpoints are balanced

- Yes, links are relevant and work

- Mostly yes, but there are a few instances where citations are needed and should be added

- Yes, info appears up to date. But I do encourage you to look for some more recent reviews. Though I am sure the info is still relevant

Lead

- What do steroids do? How does deficiency lead to those symptoms?

- Briefly say what separates an adrenal crisis from adrenal insufficiency because they sound very similar

Types

- For secondary, mineralocorticoid production being spared is not clear. Consider making the connection that ACTH does not influence mineralocorticoid production

- For secondary, exogenous use should link to a Cushing article and you should mention how they may have dramatically different symptoms than you'd find in adrenal insufficiency (high blood pressure)

Pathophysiology

- Image for the zonas would be helpful. Can probably just grab one of the images they use in the zona wiki articles

- Either briefly explain what negative feedback is or link to a relevant article

- "Primarily in primary" sounds weird. Switch to mainly, mostly, predominantly, etc

- Again, need to say something about how ACTH specifically doesn't regulate mineralocorticoid production and that is why it is only affected in primary. Especially because your image refers to the adrenal cortex, so it would be helpful to show there are different parts to the adrenal cortex and that its 3 components are all affected only in primary disease. There is an in-depth explanation farther down in the article, but it should probably still be addressed briefly in the two instances I mentioned

Causes

- It might help to give more attention/explanation for the main causes of insufficiency. The autoimmune cause is well explained, but could talk more about how TB and mets facilitate the destruction of the gland in advanced disease. A layman does not understand why TB (mostly thought of as a disease of the lungs) would affect the adrenals

Diagnosis

- The main source you use for this section is over 20 years old. I'm sure a lot of it is still find, but should also find a more recent source to back it up, especially when it comes to making diagnosis which surely is subject to change over time with new tests and protocols

- In the table, while is aldosterone low in tertiary?

Treatment

- *clears throat* ~~"Treat the underlying cause"~~

No sections for epidemiology or prognosis?

Good work!

Nobajoe (talk) 15:43, 16 November 2022 (UTC)

open access overview articles

Endotext: Adrenal insufficiency - https://pubmed.ncbi.nlm.nih.gov/25905309/ -- more detailed

StatPearls: Adrenal insufficiency - https://pubmed.ncbi.nlm.nih.gov/28722862/ Oddcomb (talk) 01:49, 2 November 2022 (UTC)

Central adrenal insufficiency

First time editor, forgive the noobness.

• What I think should be changed:

We should mention somewhere that secondary and tertiary adrenal insufficiency are collectively referred to as central adrenal insufficiency. Also consider pointing that search phrase to the adrenal insufficiency page.

• Why it should be changed:

Medical literature will sometimes use the phrase "central adrenal insufficiency" without clarifying that this includes both secondary and tertiary adrenal insufficiency. Users searching for that phrase (myself included) can have a hard time understanding the connection.

• References supporting the possible change (format using the "cite" button):

AscendingOlympus (talk) 16:29, 16 June 2023 (UTC)

References