DDx Adrenal Insufficiency

· Primary:

· Acute (adrenal crisis)

· Acute stress with glands incapable of responding

· Corticosteroid rapid withdrawal

· Massive adrenal hemorrhage

· Newborns following difficult delivery

· Anticoagulated patients

· Postoperative with DIC

· Bacteremic infection (Waterhouse-Friderichsen syndrome)

· Other infection:

· TB

· fungi

· Chronic (Addison disease)

· Congenital adrenal hypoplasia

· Congenital adrenal hyperplasia

· X-linked adrenal hypoplasia (DAX-1)

· “miniature” type adrenal hypoplasia

· Adrenoleukodystrophy (ALD)

· Autoimmune adrenal insufficiency

· Autoimmune polyendocrinopathy syndrome type 1 (AIRE-1)

· Autoimmune polyendocrinopathy syndrome type 2 (polygenic)

· Isolated autoimmune adrenalitis (polygenic)

· AIDS

· Amyloidosis

· Sarcoidosis

· Hemochromatosis

· Metastatic carcinoma

· Drug and steroid-induced

· Secondary:

· Hypothalamic pituitary disease

· Neoplasm

· Inflammation

· Infection

· Hypothalamic pituitary suppression

· Long term steroid use

· Steroid-producing neoplasms

References:

· Kumar V, Fausto N, Abbas A. Robbins & Cotran Pathologic Basis of Disease, Seventh Edition. 7th ed. Saunders; 2004.