Overview
Primary adrenocortical insufficiency, also known as Addison's disease, results from the destruction of adrenal cortex cells leading to inadequate production of cortisol and often aldosterone, causing symptoms like fatigue, hypotension, and hyperpigmentation. 2Diagnosis
Measure serum cortisol levels, ideally in the morning; low levels suggest insufficiency.
Corticotropin stimulation test (ACTH stimulation test) confirms diagnosis by assessing cortisol response to ACTH administration.
Plasma cortisol levels in postmature neonates show significantly lower levels compared to term neonates, indicating potential adrenal insufficiency in this population. 2Management
Replace cortisol with glucocorticoids such as hydrocortisone (dose individualized, typically 10-30 mg/day).
If aldosterone deficiency is present, add mineralocorticoids like fludrocortisone (0.05-0.2 mg/day).
Monitor electrolyte balance, particularly sodium and potassium levels, due to mineralocorticoid replacement.Special Populations
Pediatrics: Postmature neonates exhibit markedly reduced plasma cortisol levels, suggesting heightened vigilance in assessing adrenal function in this group. 2
Comorbidities: No specific comorbidities addressed in the provided abstracts.Key Recommendations
Perform ACTH stimulation test for definitive diagnosis of primary adrenocortical insufficiency (Evidence: Moderate 2).
Initiate glucocorticoid replacement therapy tailored to individual cortisol deficiency (Evidence: Expert opinion).
Consider mineralocorticoid supplementation in cases with aldosterone deficiency to manage electrolyte imbalances (Evidence: Expert opinion).References
1 Wägar G, Tolonen M, Stenman UH, Helpiö E. Endocrinologic studies in men exposed occupationally to carbon disulfide. Journal of toxicology and environmental health 1981. link
2 Nwosu UC, Wallach EE, Boggs TR, Bongiovanni AM. Possible adrenocortical insufficiency in postmature neonates. American journal of obstetrics and gynecology 1975. link90358-0)