CLINICAL-IMMUNOLOGICAL PREDICTORS OF EARLY DIAGNOSIS AND TREATMENT OF PRIMARY CHRONIC ADRENAL INSUFFICIENCY

Abstract

Primary chronic adrenal insufficiency (PAI) is an uncommon but high-impact endocrine disorder in which progressive adrenal cortex failure leads to chronic glucocorticoid and—often—mineralocorticoid deficiency. Delayed recognition remains a major clinical problem because early symptoms are non-specific and diagnosis is frequently made only after adrenal crisis. This article reviews clinical and immunological predictors that can enable earlier diagnosis and more timely, individualized treatment. On the clinical side, persistent fatigue, weight loss, orthostatic hypotension, salt craving, hyperpigmentation, recurrent gastrointestinal symptoms, and characteristic biochemical signals (hyponatremia, hyperkalemia, elevated ACTH, elevated plasma renin activity, low/normal morning cortisol, and impaired response to ACTH stimulation) form a pattern that should prompt targeted testing.