Adrenal Insufficiency: Symptoms, Causes & Treatment

Overview

Adrenal insufficiency is a chronic endocrine condition where your adrenal glands, the small, triangle-shaped glands located on top of each kidney, do not produce enough of the hormone cortisol. Cortisol helps regulate your body’s stress response, blood pressure, metabolism, and immune system function. In some cases, the adrenal glands also don’t make enough aldosterone, a hormone that helps control blood pressure and balance sodium and potassium levels in your body. There are two main types: primary adrenal insufficiency (also called Addison’s disease), which is caused by damage to the adrenal glands themselves, and secondary adrenal insufficiency, which occurs when the pituitary gland in your brain doesn’t send enough of the signal hormone ACTH (adrenocorticotropic hormone) to tell the adrenal glands to make cortisol.

Signs & Symptoms

Early symptoms of adrenal insufficiency often develop slowly over months and can be easy to mistake for other common, less serious conditions. As the hormone deficiency worsens, symptoms become more severe and can become life-threatening if left untreated.

• Fatigue and persistent muscle weakness that does not improve with rest
• Unexplained weight loss and decreased appetite
• Darkening of the skin, especially on the elbows, knees, knuckles, and inside of the cheeks (a hallmark of primary adrenal insufficiency)
• Low blood pressure, especially when standing up quickly (orthostatic hypotension)
• Unusual salt cravings
• Nausea, vomiting, or chronic abdominal pain
• Joint or muscle aches
• Irritability, depression, or difficulty concentrating

Causes & Risk Factors

Primary adrenal insufficiency (Addison’s disease) is most often caused by an autoimmune disorder, where your immune system mistakenly attacks the adrenal glands. Other causes include fungal or bacterial infections (like tuberculosis), cancer that spreads to the adrenal glands, or bleeding into the adrenal glands. Secondary adrenal insufficiency is usually caused by a problem with the pituitary gland, such as a tumor, surgery, or radiation to the brain, or suddenly stopping long-term use of corticosteroid medications (like prednisone) that suppress your body’s natural cortisol production.

Diagnosis

Diagnosing adrenal insufficiency starts with a review of your symptoms, medical history, and a physical exam. Your provider will likely order blood tests to measure your cortisol and ACTH (adrenocorticotropic hormone) levels, usually drawn early in the morning when cortisol levels are highest. If initial tests suggest a deficiency, you may need an ACTH stimulation test, where you are given a synthetic form of ACTH and your cortisol levels are measured before and after the injection to see how well your adrenal glands respond. Imaging tests like CT or MRI scans may also be used to check for abnormalities in your adrenal glands or pituitary gland.

Treatment & Management

There is no cure for most forms of adrenal insufficiency, but it can be managed effectively with lifelong hormone replacement therapy. For primary adrenal insufficiency, you will likely take hydrocortisone (to replace cortisol) and fludrocortisone (to replace aldosterone). For secondary adrenal insufficiency, you will usually only need hydrocortisone replacement, as aldosterone production is usually not affected. Your provider will work with you to find the right dose for your body, and you will learn how to temporarily increase your dose during times of physical stress (like illness, injury, or surgery) to prevent adrenal crisis.

• Take your prescribed hormone replacement medication exactly as directed, at the same time each day
• Learn and follow your provider’s specific instructions for increasing your cortisol dose during illness, injury, or other times of stress
• Carry an emergency hydrocortisone injection kit with you at all times and know how to use it
• Wear a medical alert bracelet or necklace that clearly identifies your adrenal insufficiency diagnosis
• Keep a 2-week supply of extra medication with you when traveling or away from home, in case of emergencies

Living With It

With proper treatment and regular monitoring, most people with adrenal insufficiency can live full, active lives. It’s important to attend follow-up appointments with your endocrinologist every 6 to 12 months to check your hormone levels, blood pressure, and electrolyte levels, and adjust your medication doses as needed. Let close friends, family, and coworkers know about your condition and how to recognize signs of adrenal crisis, so they can help if you are unable to care for yourself. Never stop taking corticosteroid medications abruptly if you have been prescribed them long-term — always taper off under your provider’s supervision to avoid triggering adrenal insufficiency.