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Adrenal Insufficiency C032

Document
Last amended 
19 November 2019
Current RMA Instruments

Reasonable Hypothesis SOP

71 of 2018

Balance of Probabilities SOP

72 of 2018

Changes from previous Instruments

SOP Bulletin 204

ICD Coding
  • ICD-9-CM Codes: 017.6, 255.4, 255.5, 036.3
  • ICD-10-AM Codes: E27.1, E27.2, E27.3, E27.4, E89.6, A18.7, A39.1
Brief description

The adrenal gland produces the glucocorticoid cortisol and the mineralocorticoid aldosterone.  It is also a secondary site for androgen production.  Deficiency of these hormones can cause a wide range of symptoms including weakness, skin pigmentation, weight loss and low blood pressure. This SOP does not cover disease or injury of the adrenal medulla, which is involved in the secretion of adrenaline and noradrenaline.

Confirming the diagnosis

The diagnosis can be complex and specialist opinion will generally be required.  Laboratory evaluation of hormone levels will be required, with the appropriate testing dependent on the clinical presentation.  Imaging of the adrenal glands or pituitary gland may also be needed.

The appropriate medical specialist is an endocrinologist or general physician.

Additional diagnoses covered by SOP
  • Acute hypoadrenalism
  • Addison’s disease
  • Addisonian crisis
  • Adrenal crisis/Adrenocortical crisis
  • Chronic hypoadrenalism
  • Drug-induced hypoadrenalism
  • Primary adrenocortical insufficiency
  • Secondary adrenocortical insufficiency
Conditions excluded from SOP
  • Adrenal medullary insufficiency#
  • Cushing disease/syndrome*
  • Hereditary forms of adrenal insufficiency#
  • Hypopituitarism*

* another SOP applies

# non-SOP condition

Clinical onset

Time of clinical onset will generally be based on when symptoms, later confirmed to be due to adrenal insufficiency, first developed.

Clinical worsening

Clinical worsening may be in the form of an adrenal crisis, which is defined in the SOP.  More general worsening of chronic adrenal insufficiency may also occur, manifest by a deterioration in measured hormone levels and a worsening of symptoms.