The hormonal deficiencies were analyzed at the moment of the diagnosis and in the last check-up, and this analysis found the following proportions: for hypothyroidism, 86.7% versus 92% (p = 0.001); for hypocortisolism, 62% versus 78% (p = 0.001); for hypogonadism, 67% versus 76% (p = 0.001); for hyposomatotropism, 89% versus 94% (p = 0.002); and for panhypopituitarism, 67.8% versus 78% (p = 0.001) (Table 1).
While urinary cortisol excretion has been shown to be helpful in the diagnostic approach to hypercortisolism, significant interindividual variations in both primary and secondary AI do not favour this method in hypocortisolism .
Hypercortisolism and and hypocortisolism are considered rare diseases, but their incidence seems to be highly underestimated because their onset is often insidious with nonspecific signs and symptoms, and the biochemical picture remains murky.
By contrast, hypocortisolism has also been identified in groups that are exposed to chronic stress, including children raised in Romanian orphanages (Gunnar & Vazquez, 2001) and other chronically stressful environments, such as being an ethnic minority (DeSantis et al., 2007).
Moreover, in the review by Kakiashvili et al., only studies showing an association between hypocortisolism and burnout were referred to, although there is a vast amount of literature showing the opposite or no association at all [e.g., 7,18,21,26,27].
The low cortisol and high ACTH levels reflect a state of primary adrenal hypocortisolism; however, adrenal insufficiency was not manifesting itself as a classical Addison's disease as the raised corticosterone production has weaker glucocorticoid effect.