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difference between primary and secondary adrenal insufficiency and hypopituitarism

Wanted to share part of a study I read involving the difference between primary adrenal insufficiency(Addison's disease) and secondary adrenal insufficiency (caused by hypopituitarism) symptoms are the same but a few of the signs are current as well as labs, which I never knew and thought might be helpful.


Symptoms are nearly identical to those of primary adrenal insufficiency but can be differentiated by lack of hyperpigmentation. Hyperpigmentation occurs in a long feedback loop in which a cortisol deficiency results in increased production of ACTH by the pituitary. The ACTH precursor coupled to melanocyte-stimulating hormone is not produced in patients with pituitary disease, and therefore, hyperpigmentation does not take place.

Patients with secondary adrenal insufficiency usually are eukalemic. This differs from primary adrenal insufficiency, in which patients develop hyponatremia and hyperkalemia. Aldosterone secretion is not affected, as it does not depend on corticotropin but instead on the renin-angiotensin axis.
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