The clinical presentation of adrenal insufficiency is variable, depending on whether the onset is acute, leading to adrenal crisis, or chronic, with symptoms that are more insidious and vague. Therefore, the diagnosis of adrenal insufficiency depends upon a critical level of clinical suspicion. Adrenal crisis should be considered in any patient who presents with peripheral vascular collapse (vasodilatory shock), whether or not the patient is known to have adrenal insufficiency. Likewise, isolated corticotropin (ACTH) deficiency, although rare, should be considered in any patient who has unexplained severe hypoglycemia or hyponatremia. (See "Clinical manifestations of adrenal insufficiency in adults" .)
A discussion on stress should include recognition of Dr. Hans Selye. His classic work on stress ( The Stress of Life , McGraw- Hill Book Co., .) and his many other publications report “that our various internal organs, especially the endocrine glands and the nervous system, help to adjust us to the constant changes which occur in and around us. He calls this adjustment the General Adaptation Syndrome. Selye concluded that the adrenals were the body’s prime reactors to stress. He stated that the adrenals “…are the only organs that do not shrink under stress; they thrive and enlarge. If you remove them, and subject an animal to stress it can’t live. But if you remove them, and then inject extract of cattle adrenals (cortex), stress resistance will vary in direct proportion to the amount of the injection, and even be put back to normal.” Likewise a person’s stress resistance will vary with the competence of his adrenals, but continually stressing the adrenals finally depletes them.
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