27th May 2025

Background

In primary adrenal insufficiency (PAI) there is ablation of the adrenal cortex resulting in a deficiency of all steroid hormones. The hypothalamic-pituitary axis (HPA) aims to correct low cortisol levels through increased adrenocorticotropic hormone (ACTH) production, where α-melanocyte-stimulating-hormone is produced as a by-product. Therefore insidious PAI commonly presents with mucocutaneous hyperpigmentation, as well as fatigue, weakness, hypotension, anorexia, nausea and vomiting. It can also present acutely with hypovolaemic shock, acute abdominal pain, fever and vomiting.