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.
Endocrinologists are specialists in hormonal diseases, including adrenal and pituitary conditions that cause secondary adrenal insufficiency. An endocrinologist will have more training and experience in properly diagnosing and treating secondary adrenal insufficiency than most physicians. Most cases of permanent secondary adrenal insufficiency should be managed by an endocrinologist. In cases of steroid withdrawal for the treatment of medical conditions, endocrinologists often work with the primary physician or specialist in that disease to assess the recovery of pituitary-adrenal reserve and provide guidance about whether long term glucocorticoid therapy is needed.