What is the most common cause of acute adrenal insufficiency?

What is the most common cause of acute adrenal insufficiency?

• A. Prolonged steroid use with abrupt withdrawal
• B. Autoimmune destruction of the adrenal glands
• C. Adrenal hemorrhage
• D. Infectious disease

Answer: (A)

Abrupt withdrawal of prolonged exogenous corticosteroid therapy is the most common trigger for an acute adrenal crisis because chronic steroid use suppresses the hypothalamic-pituitary-adrenal axis. When steroids are stopped suddenly, the adrenals have atrophied and cannot promptly resume cortisol production, especially during stress. This leads to a sudden deficiency of cortisol with symptoms like severe weakness, nausea, vomiting, abdominal pain, hypotension, hypoglycemia, hyponatremia, and possible shock. Autoimmune destruction is a common cause of chronic primary adrenal insufficiency, but it is not the usual precipitant of an acute crisis. Adrenal hemorrhage and infectious diseases can cause acute insufficiency but occur less frequently as triggers compared with withdrawal of steroids.

Abrupt withdrawal of prolonged exogenous corticosteroid therapy is the most common trigger for an acute adrenal crisis because chronic steroid use suppresses the hypothalamic-pituitary-adrenal axis. When steroids are stopped suddenly, the adrenals have atrophied and cannot promptly resume cortisol production, especially during stress. This leads to a sudden deficiency of cortisol with symptoms like severe weakness, nausea, vomiting, abdominal pain, hypotension, hypoglycemia, hyponatremia, and possible shock.

Autoimmune destruction is a common cause of chronic primary adrenal insufficiency, but it is not the usual precipitant of an acute crisis. Adrenal hemorrhage and infectious diseases can cause acute insufficiency but occur less frequently as triggers compared with withdrawal of steroids.