|Adrenal Insufficiency (AI) is defined as deficient production or action of glucocorticoids resulting from either a structural damage of adrenal glands, namely ââprimary adrenal insufficiencyââ, or an impairment of the hypothalamic-pituitary axis or ââsecondary adrenal diseaseââ. Primary AI is rare in general population, with an annual incidence of approximately 6/million adults/year and prevalence of 40 to 110 cases/million adults and autoimmune diseases are the most frequent causes in developed countries. Long-term glucocorticoid therapy is the most frequent cause of secondary AI, however any process that impairs the ability of the hypothalamic-pituitary axis to secrete ACTH can cause secondary adrenal insufficiency (i.e. Pituitary or suprasellar tumors).
During critical illness (such as septic shock, severe communityacquired pneumonia, trauma, head injury, burns) AI is frequent, and is associated with a worse prognosis. It has been described as Relative Adrenal Insufficiency (RAI), which is an inadequate glucocorticoid activity relative to the severity of illness.
Review: Adrenal Insufficiency in Liver Disease: Giuseppe Fede*, Luisa Spadaro and Francesco Purrello