Exogenous adrenal insufficiency
Key points
- Exogenous adrenal insufficiency is a condition of low levels of hormones released by the adrenal glands, caused by factors other than problems with the glands themselves.
- Glucocorticoids such as prednisone, hydrocortisone, and dexamethasone are similar to natural hormones produced by the adrenal glands.
- Typically, a patient who has been taking steroids and has developed this condition will exhibit features similar to Cushing's syndrome (round face, obesity around the waist, abdominal striae), while having symptoms of adrenal insufficiency.
- Patients usually respond to administration of glucocorticoids.
Alternative names
Drug-induced adrenal insufficiency
Definition
Exogenous adrenal insufficiency is a condition of low levels of hormones released by the adrenal glands, caused by factors other than problems with the glands themselves. See Addison's disease for information on adrenal deficiency caused by problems within these glands.
Causes, incidence, and risk factors
Glucocorticoids such as prednisone, hydrocortisone, and dexamethasone are similar to natural hormones produced by the adrenal glands. They are used to treat a variety of conditions including many inflammatory diseases such as asthma and some forms of arthritis.
When people are treated with glucocorticoids, the production of adrenal hormones may decrease because of effects on the pituitary, the master gland that controls the adrenals.
If glucocorticoids are stopped or decreased too quickly, the adrenal glands may not begin making their own hormones again fast enough to meet the body's needs, and symptoms of adrenal insufficiency result. This condition usually occurs when these drugs are given systemically (by pills or injections), rather than topically (on the skin) or in inhaled forms. Higher doses and longer treatment increase the risk.
Abrupt cessation of treatment with glucocorticoids is the most common cause of adrenal insufficiency.
Other drugs that may cause adrenal insufficiency include the following:
- Megestrol
- Ketoconazole
- Metyrapone
- Aminoglutethimide
- Mitotane
These drugs have direct effects on the adrenal glands, decreasing glucocorticoid production.
Symptoms
Symptoms may include:
- Weakness
- Lethargy, fatigue
- Nausea and vomiting
- Arthralgias, myalgias (muscle pains)
- Low blood pressure (hypotension) that may cause light-headedness or fainting when the affected person stands after sitting or lying down
- Shock
Signs and tests
Typically, a patient who has been taking steroids and has developed this condition will exhibit features similar to Cushing's syndrome (round face, obesity around the waist, abdominal striae), while having symptoms of adrenal insufficiency.
Frequently asked questions
What is exogenous adrenal insufficiency?
Exogenous adrenal insufficiency is a condition of low levels of hormones released by the adrenal glands, caused by factors other than problems with the glands themselves. See Addison's disease for information on adrenal deficiency caused by problems within these glands.
What are the risk factors for exogenous adrenal insufficiency?
Glucocorticoids such as prednisone, hydrocortisone, and dexamethasone are similar to natural hormones produced by the adrenal glands. They are used to treat a variety of conditions including many inflammatory diseases such as asthma and some forms of arthritis. When people are treated with glucocorticoids, the production of adrenal hormones may decrease because of effects on the pituitary, the master gland that controls the adrenals. If glucocorticoids are stopped or decreased too quickly, the adrenal glands may not begin making their own hormones again fast enough to meet the body's needs, and symptoms of adrenal insufficiency result.
What are the symptoms of exogenous adrenal insufficiency?
- Weakness
- Lethargy, fatigue
- Nausea and vomiting
- Arthralgias, myalgias (muscle pains)
- Low blood pressure (hypotension) that may cause light-headedness or fainting when the affected person stands after sitting or lying down
- Shock
Written and revised by
David Cohen, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.