Adrenal Insufficiency

Adrenal crisis, based on lack of response of adrenal hormones, can result in abdominal pain, nausea, vomiting, and circulatory collapse. Adrenal insufficiency, which is based on inadequate response of adrenal hormones, is associated with fatigue, weight loss, dizziness, salt craving, and hyperpigmentation in skin areas. The adrenal gland insufficiency may be caused by adrenal gland destruction, whether by autoimmune condition, trauma, hemorrhage, infection, or by suppression due to exogenous steroids. Laboratory values associated with adrenal insufficiency include hyponatremia and hyperkalemia. Cortisol level and cosyntropin stimulation are standard testing for diagnosis of adrenal insufficiency. An orthopaedic surgeon should be aware of this condition in patients who have prior steroid inhalation, oral medication, or injections, and if the patient is on medication which inhibits steroid metabolism, such as certain human immunodeficiency virus (HIV) medication.