Essential Facts on the Go: Internal Medicine (28 page)

Pituitary hemorrhage: Sheehan syndrome, intraoperative

Pituitary infiltration: TB, actinomycosis, sarcoidosis, histiocytosis X, Wegener’s granulomatosis, metastases

Drug induced: glucocorticoid excess

Clinical presentation

Glucorticoid deficiency: fatigue, weight loss, myalgias, fever, eosinophilia, hypoglycemia, hypotension, orthostasis, hyponatremia (lose inhibition of ADH by cortisol)

Mineralocorticoid deficiency: abdominal pain, nausea/vomiting, orthostasis, hypotension, hyponatremia (Na wasting), hyperkalemia, hyperpigmentation

VI_4_b
Adrenal Insufficiency in Adults

Diagnosis

Serum cortisol levels

Check at 6 a.m.–8 a.m. when levels are the highest: normal = 10–20 mcg/dL, < 3 mcg/dL consistent with AI

ACTH stimulation test

Perform if cortisol levels are low

Perform in the morning

Check ACTH and cortisol at time 0