Adrenal insufficiency — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 71 of 2018

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting adrenal insufficiency or death from adrenal insufficiency with the circumstances of a person's relevant service:

1. (1)
   having an autoimmune disorder involving the adrenal glands at the time of the clinical onset of adrenal insufficiency;
2. (2)
   having infiltration of the adrenal glands due to a disorder from the specified list of infiltrative disorders at the time of the clinical onset of adrenal insufficiency;

   Note: specified list of infiltrative disorders is defined in the Schedule 1 - Dictionary.

3. (3)
   having infection with human immunodeficiency virus before the clinical onset of adrenal insufficiency;
4. (4)
   having an injury or surgery to: (a) both adrenal glands, or (b) a single adrenal gland: (i) where there is only one functional adrenal gland; or (ii) as surgical treatment for Cushing syndrome; within the one year before the clinical onset of adrenal insufficiency;
5. (5)
   having haemorrhage or infarction of: (a) both adrenal glands, or (b) a single functional adrenal gland, where there is only one functional adrenal gland; within the one year before the clinical onset of adrenal insufficiency;

   Note: Common causes of adrenal haemorrhage or infarction include trauma to the adrenal gland, heparin-induced thrombocytopaenia, anticoagulant therapy, antiphospholipid syndrome, sepsis, malignancy and haematological disorder.

6. (6)
   having an infection of the adrenal glands with an organism from the specified list of infectious organisms at the time of the clinical onset of adrenal insufficiency;

   Note: specified list of infectious organisms is defined in the Schedule 1 - Dictionary.

7. (7)
   being treated with a drug or a drug from a class of drugs from Specified List 1 of drugs within the three months before the clinical onset of adrenal insufficiency;

   Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

8. (8)
   having glucocorticoid therapy as specified, before the clinical onset of adrenal insufficiency, and where the glucocorticoid therapy as specified has ceased or decreased, the last dose of the therapy was received within the one year before the clinical onset of adrenal insufficiency;

   Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

9. (9)
   being treated with medroxyprogesterone acetate or megestrol acetate for a malignant disease or human immunodeficiency virus infection: (a) for a continuous period of at least four weeks before the clinical onset of adrenal insufficiency; and (b) where such treatment has ceased, the last dose was received within the three months before the clinical onset of adrenal insufficiency;
10. (10)
    having hypopituitarism with adrenocorticotrophic hormone deficiency, at the time of the clinical onset of adrenal insufficiency;
11. (11)
    having a critical illness or injury within the one year before the clinical onset of adrenal insufficiency;

    Note: critical illness or injury is defined in the Schedule 1 - Dictionary.

12. (12)
    for adrenal crisis only, having an acute, severe stressor within the seven days before the clinical onset of adrenal insufficiency;

    Note: acute, severe stressor and adrenal crisis are defined in the Schedule 1 - Dictionary.

13. (13)
    having an autoimmune disorder involving the adrenal glands at the time of the clinical worsening of adrenal insufficiency;
14. (14)
    having infiltration of the adrenal glands due to a disorder from the specified list of infiltrative disorders at the time of the clinical worsening of adrenal insufficiency;

    Note: specified list of infiltrative disorders is defined in the Schedule 1 - Dictionary.

15. (15)
    having infection with human immunodeficiency virus before the clinical worsening of adrenal insufficiency;
16. (16)
    having an injury or surgery to: (a) both adrenal glands, or (b) a single adrenal gland: (i) where there is only one functional adrenal gland; or (ii) as surgical treatment for Cushing syndrome; within the one year before the clinical worsening of adrenal insufficiency;
17. (17)
    having haemorrhage or infarction of: (a) both adrenal glands, or (b) a single functional adrenal gland, where there is only one functional adrenal gland; within the one year before the clinical worsening of adrenal insufficiency;

    Note: Common causes of adrenal haemorrhage or infarction include trauma to the adrenal gland, heparin-induced thrombocytopaenia, anticoagulant therapy, antiphospholipid syndrome, sepsis, malignancy and haematological disorder.

18. (18)
    having an infection of the adrenal glands with an organism from the specified list of infectious organisms at the time of the clinical worsening of adrenal insufficiency;

    Note: specified list of infectious organisms is defined in the Schedule 1 - Dictionary.

19. (19)
    being treated with a drug or a drug from a class of drugs from Specified List 1 of drugs within the three months before the clinical worsening of adrenal insufficiency;

    Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

20. (20)
    having glucocorticoid therapy as specified, before the clinical worsening of adrenal insufficiency: (a) where the glucocorticoid therapy as specified is not being taken for the treatment of adrenal insufficiency; and (b) where the glucocorticoid therapy as specified has ceased or decreased, the last dose of the therapy was received within the one year before the clinical worsening of adrenal insufficiency;

    Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

21. (21)
    being treated with medroxyprogesterone acetate or megestrol acetate for a malignant disease or human immunodeficiency virus infection: (a) for a continuous period of at least four weeks before the clinical worsening of adrenal insufficiency; and (b) where such treatment has ceased, the last dose was received within the three months before the clinical worsening of adrenal insufficiency;
22. (22)
    having hypopituitarism with adrenocorticotrophic hormone deficiency, at the time of the clinical worsening of adrenal insufficiency;
23. (23)
    having a critical illness or injury within the one year before the clinical worsening of adrenal insufficiency;

    Note: critical illness or injury is defined in the Schedule 1 - Dictionary.

24. (24)
    for adrenal crisis only, having an acute, severe stressor within the seven days before the clinical worsening of adrenal insufficiency;

    Note: acute, severe stressor and adrenal crisis are defined in the Schedule 1 - Dictionary.

25. (25)
    inability to obtain appropriate clinical management for adrenal insufficiency;

Aggravation-only factors: the factors in subsections 9(13) to 9(25) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.