The Changing Clinical Spectrum of Adrenal Insufficiency
Authors: Robert M. Carey
Journal: Annals of Internal Medicine (1997)

Editorials15 December 1997The Changing Clinical Spectrum of Adrenal InsufficiencyRobert M. Carey, MDRobert M. Carey, MDUniversity of Virginia School of Medicine; Charlottesville, VA 22908.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-12-199712150-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The clinical spectrum of primary adrenal insufficiency has changed substantially over the past decade as a result of the emergence of new disease patterns, improved understanding of clinical presentations, and the impact of molecular genetics. I comment here on five clinical entities that have emerged as new diagnostic or therapeutic challenges in the 1990s.Adrenal insufficiency is increasingly recognized in patients with AIDS [1-3], and it correlates with stage of progression of HIV infection. More than 50% of patients with AIDS have pathologic evidence of necrotizing adrenalitis, but the degree of adrenal destruction is usually less than 50%. Clinical adrenal ...References1. Piedrola G, Casado JL, Lopez E, Moreno A, Perez-Elias MJ, Garcia-Robles R. Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome. Clin Endocrinol (Oxf). 1996; 45:97-101. Google Scholar2. Freda PU, Wardlaw SL, Brudney K, Goland RS. Primary adrenal insufficiency in patients with the acquired immunodeficiency syndrome: a report of five cases. J Clin Endocrinol Metab. 1994; 79:1540-5. Google Scholar3. Amason JA, Graziano FM. Adrenal insufficiency in the antiphospholipid antibody syndrome. Semin Arthritis Rheum. 1995; 25:109-16. Google Scholar4. Bevilacqua M. Hyponatremia in AIDS. Baillieres Clin Endocrinol Metab. 1994; 8:837-48. Google Scholar5. May ME, Vaughan ED Jr, Carey RM. Adrenocortical insufficiency-clinical aspects. In: Vaughan ED Jr, Carey RM, eds. 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X-linked adrenoleukodystrophy is a frequent cause of idiopathic Addison's disease in young adult male patients. J Clin Endocrinol Metab. 1996; 81:470-4. Google Scholar21. Tsigos C, Arai K, Latronico AC, DiGeorge AM, Rapaport R, Chrousos GP. A novel mutation of the adrenocorticotropin receptor (ACTH-R) gene in a family with the syndrome of isolated glucocorticoid deficiency, but no ACTH-R abnormalities in two families with the triple A syndrome. J Clin Endocrinol Metab. 1995; 80:2186-9. Google Scholar22. Weber A, Clark AJ. Mutations of the ACTH receptor gene are only one cause of familial glucocorticoid deficiency. Hum Mol Genet. 1994; 3:585-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Virginia School of Medicine; Charlottesville, VA 22908.Corresponding Author: Robert M. Carey, MD, Box 395, University of Virginia Health Sciences Center, Charlottesville, VA 22908. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byNeuromuscular Manifestations of Acquired Metabolic, Endocrine, and Nutritional DisordersSteroid Therapy in Adrenal InsufficiencyClinical implications for biochemical diagnostic thresholds of adrenal sufficiency using a highly specific cortisol immunoassayThe Adrenal CortexNeurologic complications of disorders of the adrenal glandsNeurologic complications of multiple endocrine syndromesCardiovascular Manifestations of Endocrine DysfunctionThe Adrenal CortexNeuromuscular Manifestations of Acquired Metabolic, Endocrine, and Nutritional DisordersAddison's Disease From Non-Hodgkin's Lymphoma With Normal-Size Adrenal GlandsCT diagnosis of acute adrenal insufficiency due to bilateral adrenal haemorrhageNeurohormonal FactorsRecognition and Management of Adrenal EmergenciesAdrenal hemorrhage mimicking an acute abdomenAntiphospholipid syndrome and endocrine damage: why bilateral adrenal thrombosis?Autoantibodies in autoimmune polyendocrine syndrome type IIAdrenal Insufficiency in Critically Ill PatientsPrimary hypoadrenalism assessed by the 1 μg ACTH test in hospitalized patients with active pulmonary tuberculosis 15 December 1997Volume 127, Issue 12Page: 1103-1105KeywordsAIDSAdrenocorticotropic hormoneAutoantibodiesCholesterolEnzymesFatty acidsHemorrhageSteroidogenesisThrombosisType 1 diabetes Issue Published: 15 December 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. 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