Adrenal insufficiency is a condition that occurs when the adrenal glands do not produce enough of certain hormones, including cortisol.
Disruption of these hormones can cause a range of symptoms, including chronic fatigue, muscle weakness, and abdominal pain.
There are several types of adrenal insufficiency, including Addison’s disease, also called primary adrenal insufficiency.
All types of adrenal insufficiency are rare. Around 1 in 100,000 people in the United States have Addison’s disease. Secondary adrenal insufficiency is more common, while there is little data about the prevalence of tertiary adrenal insufficiency.
This article discusses the different types of adrenal insufficiency, symptoms, and treatment options.
The adrenal glands are small glands positioned above the kidneys. They produce vital hormones, including cortisol.
Adrenal insufficiency is when the adrenal glands do not produce enough of certain hormones. It leads to low levels of cortisol, a stress hormone that is important for many bodily functions.
There are three types of adrenal insufficiency:
- Primary adrenal insufficiency, or Addison’s disease: Damage to the adrenal glands affects its production of hormones.
- Secondary adrenal insufficiency: The brain’s pituitary gland does not produce enough adrenocorticotropic, a hormone that influences cortisol production in the adrenal glands. This leads to low hormone levels.
- Tertiary adrenal insufficiency: The hypothalamus in the brain, a region that influences hormone production in the adrenal glands, produces too little corticotropin-releasing hormone (CRH), leading to low hormone levels.
The adrenal hormones influence many bodily functions. Examples of these hormones include cortisol, which helps control blood pressure, inflammation, and metabolism, while aldosterone balances minerals in the blood.
By limiting these hormones, adrenal insufficiency causes a wide range of symptoms, from weakness to low blood sugar levels.
Adrenal insufficiency can cause many types of symptoms, which are often initially mild but worsen over time.
All types of adrenal insufficiency have similar symptoms. The most common symptoms of adrenal insufficiency include:
- chronic fatigue or extreme tiredness
- muscle weakness
- decreased appetite and weight loss
- abdominal pains
Other symptoms can include:
- joint pain
- low blood pressure
- low blood sugar
- irregular menstruation
- loss of sex drive
- darkening of the skin, such as the elbows and knees
In some cases, people with the condition can experience an adrenal crisis. This is where symptoms suddenly worsen, usually due to illness, injury, or infection.
An adrenal crisis requires emergency treatment. Without medical intervention, the condition can become life threatening.
Addison’s disease is the result of severe damage to the adrenal cortex, which surrounds the adrenal glands.
The damage is usually due to an autoimmune reaction. This is where the body’s immune system mistakenly attacks its own healthy tissues. It is the cause of around 8–9 out of 10 cases of Addison’s disease.
It is still unclear what triggers this autoimmune reaction. The reaction is more common following surgery or any major stressor. It can also affect people living with HIV due to adverse effects from medications, secondary cancers, or acquiring an infection.
Secondary adrenal insufficiency can be due to:
- autoimmune reactions
- tumors or infections
- pituitary surgery
- brain injuries
Most cases of tertiary adrenal insufficiency occur after a person suddenly stops a long course of corticosteroid use.
This is because corticosteroids increase cortisol in the body. Long-term use causes the hypothalamus to make less CRH. After stopping corticosteroid use, the hypothalamus needs time to start producing enough CRH again.
There is currently no cure for adrenal insufficiency, but treatments can help people manage the symptoms. These options depend on the symptoms and severity of the condition.
Doctors will also consider a person’s age and general health when determining the right treatment.
Hormone replacement therapy is a common form of treatment for adrenal insufficiency, which involves replacing the hormones that the adrenal glands no longer produce, including cortisol.
To replace cortisol, doctors will usually prescribe hydrocortisone as a pill several times per day. They may also recommend fludrocortisone to balance minerals in the body without aldosterone.
Many people will need to take these medications for life. People who experience an adrenal crisis may receive treatment through an intravenous drip.
Some people with primary adrenal insufficiency can benefit from certain diets, such as a high sodium diet. Consuming additional calcium and vitamin D can support bone health in people taking corticosteroids.
The main complication of adrenal insufficiency is adrenal shock.
Adrenal shock can trigger severe symptoms without warning. It is usually the result of stress on the body, such as an injury or surgery. The condition requires immediate medical treatment.
Without treatment, adrenal shock can lead to seizures or a coma, and can be fatal.
It is not always possible to prevent many cases of adrenal insufficiency. The condition is commonly the result of an autoimmune reaction.
People can prevent tertiary adrenal insufficiency by avoiding stopping corticosteroid therapy suddenly.
The symptoms of adrenal insufficiency vary, which makes diagnosis difficult. Many of these symptoms are mild at first and may go unnoticed.
Doctors will assess the symptoms and may order further tests, which usually involves a blood sample. Medical professionals can check the hormone and mineral levels in the blood for signs of the disorder.
A doctor may also recommend medical imaging tests. For example, they might use an MRI scan to assess the health of the adrenal or pituitary glands.
Many people will not notice the early symptoms of adrenal insufficiency. However, symptoms can worsen over time and become more noticeable. Persistent feelings of tiredness, weakness, or weight-loss are common signs of the condition.
If the symptoms occur rapidly, it could be a sign of adrenal shock. In these cases, seek immediate medical care.
Adrenal insufficiency is a lifelong condition, but hormone replacement therapies can help manage symptoms.
A doctor may suggest carrying a medical alert card in case of adrenal shock. People who experience adrenal shock require immediate medical care. It may also be necessary to carry an emergency cortisol shot when traveling.
Adrenal insufficiency affects the adrenal glands and limits hormone production in the body. It mostly affects cortisol and can cause a wide range of symptoms.
Adrenal insufficiency is treatable with hormone replacement therapy. In some cases, though, adrenal shock can occur. This is a medical emergency that requires immediate treatment.