Byyny R L
Postgrad Med. 1980 May;67(5):219-25, 228. doi: 10.1080/00325481.1980.11715460.
Primary adrenal insufficiency is characterized by cortisol and aldosterone deficiency; in the secondary form, cortisol alone is decreased. The symptoms are usually nonspecific and include hypotension, weight loss, and fatigue; volume depletion, hyperkalemia, and hyperpigmentation may be present in the primary form but are uncommon in the secondary form. The most common cause of secondary adrenal insufficiency is steroid therapy, which produces adrenal suppression in relation to the dose and duration of use. Sudden withdrawal may precipitate adrenal crisis; therapy must be continued until adrenocortical function recovers. Because cortisol deficiency increases vulnerability to stress, patients with known or suspected adrenal insufficiency require glucocorticoid prophylaxis before any surgical procedure, major or minor. Hydrocortisone, not cortisone acetate, should be used.
原发性肾上腺功能不全的特征是皮质醇和醛固酮缺乏；继发性肾上腺功能不全则仅皮质醇减少。症状通常不具特异性，包括低血压、体重减轻和疲劳；原发性肾上腺功能不全可能出现血容量减少、高钾血症和色素沉着，但在继发性肾上腺功能不全中不常见。继发性肾上腺功能不全最常见的原因是类固醇治疗，其导致的肾上腺抑制与使用剂量和疗程有关。突然停药可能引发肾上腺危象；治疗必须持续至肾上腺皮质功能恢复。由于皮质醇缺乏会增加对应激的易感性，已知或疑似肾上腺功能不全的患者在进行任何手术（无论大小）前都需要糖皮质激素预防。应使用氢化可的松，而非醋酸可的松。
