Adrenalitis

Adrenalitis is inflammation of one or both adrenal glands. It can be acute or chronic and may result from infection, autoimmune processes, granulomatous or infiltrative diseases, or external spread from nearby structures. Inflammation can damage the adrenal cortex, the medulla, or both, potentially impairing production of essential steroid hormones such as cortisol and, when the cortex is involved, aldosterone.

Common causes include autoimmune adrenalitis (the most frequent cause of primary adrenal insufficiency in many regions), bacterial or tuberculous infections, fungal infections, viral infections, granulomatous diseases such as sarcoidosis, and infiltrative conditions or metastatic cancer. Adrenalitis may occur in the context of systemic illness or as a localized process.

Clinical features depend on the extent of inflammation and whether adrenal hormone production is affected. Acute adrenalitis or adrenal crisis may present with fever, abdominal or flank pain, vomiting, dehydration, and shock due to acute cortisol and mineralocorticoid deficiency. More gradual inflammation, especially autoimmune adrenalitis, often leads to fatigue, weakness, weight loss, salt cravings, low blood pressure, hyperpigmentation, hyponatremia, and hyperkalemia in primary insufficiency.

Diagnosis rests on clinical suspicion supported by laboratory tests and imaging. Serum cortisol measurement, ACTH level, and an ACTH stimulation test assess adrenal function. Electrolytes may show hyponatremia and hyperkalemia in primary disease. Autoimmune markers, infection workup, and imaging with CT or MRI help identify cause and gland morphology; adrenal biopsy is rarely required.

Treatment targets the underlying cause and any hormone deficiency. Acute adrenal crisis requires immediate intravenous hydrocortisone and fluid resuscitation. Long-term management of adrenal insufficiency involves glucocorticoid replacement (and mineralocorticoid if needed). Prognosis varies with cause and timeliness of treatment.