Publication in: Fall 2022 Issue

Secondary Adrenal Insufficiency: Diagnosis, Treatment, Complications and Black Box Warnings
Katherine Magley
Health and Wellness
Faculty Mentor(s):
Jason Wingert
Abstract / Summary:
Secondary and Primary Adrenal Insufficiency are rare endocrine pathologies. Symptoms include: diarrhea and/or constipation, rib pain (asthma like symptoms), vomiting, dizziness leading to decreased balance, brain fog, fatigue, major weight loss, flank pain, and mood complications (caused by lack of fight or flight) which leads to the body being on hyperdrive by working harder to compensate for low cortisol and increased mast cell activity as a compensatory mechanism. Secondary Adrenal Insufficiency is diagnosed through a process of testing the levels of hormones integral to the stress response, namely adrenocorticotropic hormone (ACTH) and cortisol. Adrenal crisis, caused by Secondary Adrenal Insufficiency are extremely rare but can occur. Common causes are: inhaled steroids, steroid injections and oral steroid usage. This can be prevented by putting a patient on steroid replacement therapy using prednisone or hydrocortisone. Cushing Syndrome, however, is the other extreme of SAI. Cushing Syndrome is too much cortisol production. The symptoms of Cushing Syndrome are rapid weight gain, more than normal fat deposits, stretch marks, and fatigue. One of the most reliable ways to diagnose Cushing Syndrome is an 8:00 AM cortisol check. Often treatments for Cushing Syndrome are, reducing steroids, removing steroid producing tumors, and transsphenoidal surgery. Considering all of this, a Black Box Warning may be necessary. A Black Box Warning is a warning put on a drug that warns about the major health complications it may cause. Black Box Warnings should be considered for drugs that cause Secondary Adrenal Insufficiency. With a black box warning, patients and their caregivers will be aware that these medications lead to Secondary Adrenal Insufficiency.
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