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Adrenal insufficiency occurs when the adrenal glands don't make enough of the hormone cortisol. You have two adrenal glands. They are located just above the kidneys. They work with the hypothalamus and pituitary glands in the brain. Cortisol helps break down fats, proteins, and carbohydrates in your body. It also controls blood pressure and affects how your immune system works.
Adrenal insufficiency can be primary or secondary:
Primary adrenal insufficiency. This is known as Addison's disease. It occurs when the adrenal glands are damaged. They don't make enough of the hormones cortisol and aldosterone. This condition is rare. It may occur at any age.
Secondary adrenal insufficiency. This starts when the pituitary gland doesn't make enough of the hormone ACTH (adrenocorticotropin). As a result the adrenal glands don't make enough cortisol.
What causes adrenal insufficiency?
Primary adrenal insufficiency is most often caused when your immune system attacks your healthy adrenal glands by mistake. Other causes may include:
Cancer
Fungal infections
Tuberculosis infection of the adrenal glands
Inherited disorders of the endocrine glands
A lack of the hormone ACTH leads to secondary adrenal insufficiency. That can happen if you must take certain steroids for a long time due to a health problem. For example, people with asthma or rheumatoid arthritis may need to take prednisone. Other causes include:
Pituitary gland tumors
Loss of blood flow to the pituitary
Pituitary gland is removed or you have radiation treatment of the pituitary gland
Parts of the hypothalamus are removed
What are the symptoms of adrenal insufficiency?
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You may have mild symptoms when you are under physical stress. Each person's symptoms will vary. Symptoms may include:
Weakness
Fatigue
Dizziness
Dark skin (Addison's disease only)
Bluish-black color around the nipples, mouth, rectum, scrotum, or vagina (Addison's disease only)
Weight loss
Fluid loss (dehydration)
Lack of appetite
Muscle aches
Upset stomach (nausea)
Vomiting
Diarrhea
Low blood pressure
Low sugar levels
In women, irregular or no menstrual periods
If not treated, adrenal insufficiency may lead to:
Severe belly (abdominal) pain
Extreme weakness
Low blood pressure
Kidney failure
Shock
These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.
How is adrenal insufficiency diagnosed?
Your healthcare provider will ask about your medical history. You will also need an exam. Tests that can diagnose adrenal insufficiency include:
Blood and urine tests. These can check levels of the adrenal hormones and ACTH.
Imaging tests. These include X-rays, ultrasound, and MRI.
How is adrenal insufficiency treated?
Your healthcare provider will figure out the best treatment for you based on:
Your age, overall health, and past health
How sick you are
How well you can handle certain medicines, procedures, or therapies
How long the condition is expected to last
Your opinion or preference
You will need to take hormones to replace those that your adrenal glands are not making. That mainly means cortisol. But if you have Addison's disease, you may need to take aldosterone as well.
Addison's disease can be deadly. Treatment often starts with IV (intravenous) fluids and medicines called corticosteroids. You may take these medicines by mouth or by IV. You may have to take them for the rest of your life. You may also need to take other medicines (fludrocortisones). These can help keep your body's sodium and potassium levels normal.
Weakness
Fatigue
Dizziness
Dark skin (Addison's disease only)
Bluish-black color around the nipples, mouth, rectum, scrotum, or vagina (Addison's disease only)
Weight loss
Fluid loss (dehydration)
Lack of appetite
Muscle aches
Upset stomach (nausea)
Vomiting
Diarrhea
Low blood pressure
Low sugar levels
In women, irregular or no menstrual periods
If not treated, adrenal insufficiency may lead to:
Severe belly (abdominal) pain
Extreme weakness
Low blood pressure
Kidney failure
Shock
These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.
How is adrenal insufficiency diagnosed?
Your healthcare provider will ask about your medical history. You will also need an exam. Tests that can diagnose adrenal insufficiency include:
Blood and urine tests. These can check levels of the adrenal hormones and ACTH.
Imaging tests. These include X-rays, ultrasound, and MRI.
How is adrenal insufficiency treated?
Your healthcare provider will figure out the best treatment for you based on:
Your age, overall health, and past health
How sick you are
How well you can handle certain medicines, procedures, or therapies
How long the condition is expected to last
Your opinion or preference
You will need to take hormones to replace those that your adrenal glands are not making. That mainly means cortisol. But if you have Addison's disease, you may need to take aldosterone as well.
Addison's disease can be deadly. Treatment often starts with IV (intravenous) fluids and medicines called corticosteroids. You may take these medicines by mouth or by IV. You may have to take them for the rest of your life. You may also need to take other medicines (fludrocortisones). These can help keep your body's sodium and potassium levels normal.
What are the complications of adrenal insufficiency?
You may have sudden severe symptoms. This is called acute adrenal insufficiency, or Addisonian crisis. This can occur when your body is stressed. That can happen for many reasons, such as an illness, fever, surgery, or dehydration. You may also have a crisis if you stop taking your steroids or lower the amount of your steroids suddenly. The symptoms of an Addisonian crisis include the symptoms of adrenal insufficiency or Addison's disease. But if an Addisonian crisis is not treated, it can lead to:
Shock
Seizures
Coma
Living with adrenal insufficiency
Take your medicine exactly as prescribed. You should also carry a medical alert card or tag at all times. This can make sure you get proper treatment if there is an emergency. When traveling always carry an emergency kit with a shot of cortisol.
When should I call my healthcare provider?
Any condition that stresses your body can affect how much medicine you need. Call your healthcare provider if:
You have any kind of illness, especially a fever, vomiting, or diarrhea
You become pregnant
You need surgery
Get medical help right away if you have sudden severe symptoms (Addisonian crisis).
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Key points about adrenal insufficiency (Addison's disease)
Paralysis
Adrenal insufficiency occurs when the adrenal glands don't make enough of the hormone cortisol.
The primary kind is known as Addison's disease. It is rare. It is when the adrenal glands don't make enough of the hormones cortisol and aldosterone.
Secondary adrenal insufficiency occurs when the pituitary gland doesn't make enough of the hormone ACTH. The adrenal glands then don't make enough cortisol.
Mild symptoms may be seen only when a person is under physical stress. Other symptoms may include weakness, fatigue, and weight loss.
You will need to take hormones to replace those that the adrenal glands are not making.
