Adrenal insufficiency natural history, complications and prognosis

Common complications of adrenal insufficiency include cardiovascular complications, disturbed sleep, reduced bone mineral density. Prognosis is generally excellent with replacement therapy.

• The symptoms of adrenal insufficiency usually develop in the third to fifth decade of life, and start with symptoms such as fatigue, anorexia, weight loss, nausea, abdominal pain.
• If left untreated, chronic adrenal insufficiency in the presence of precipitating factors can develop adrenal crisis presenting with acute hemodynamic compromise. ^[1]
• Up to half of patients with primary adrenal insufficiency may experience adrenal crisis prior to diagnosis. ^[2]

• Common complications of adrenal insufficiency include: ^[3]
  • Increased risk of cardiovascular complications.
  • Sleep disturbance due to disruption of circadian rhythm.
  • Decreased bone mineral density as a consequence of glucocorticoid therapy.
  • Fertility and pregnancy complications: Reduced fertility, increased risk of fetal growth restriction, preterm birth, cesarean delivery

• Prognosis is generally excellent with replacement therapy and patients are able to work, travel and participate in sports^{[4] [5]}.
• Depending on the age of the diagnosis of adrenal insufficiency the prognosis may vary. If the patient is diagnosed before the age of 40, there is increased mortality.
• Mortality is increased in patients presenting with acute adrenal crisis, infection, or associated with type 1 diabetes mellitus ^[6].
• Patients with glucocorticoid-induced adrenal insufficiency may recover hypothalamic-pituitary-adrenal axis function over months to years after discontinuation of glucocorticoids ^[2].

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