Adrenal Insufficiency (AI) is an endocrine or hormonal condition in which the adrenal glands fail to produce sufficient amounts of steroid hormones. The main hormone affected is cortisol, a hormone that plays an important role in helping the body respond to stress. However, other hormones, such as aldosterone and androgens, are also often affected.

Adrenal insufficiency can present itself in one of two ways:

Primary adrenal insufficiency - Also referred to as Addison’s disease, primary adrenal insufficiency is characterized by the inability of the adrenal glands to produce enough cortisol.

Secondary adrenal insufficiency - This is the most common type of adrenal insufficiency. Secondary adrenal insufficiency occurs when the pituitary gland is unable to make enough adrenocorticotropin hormone (ACTH). ACTH sends a signal to the adrenal glands and stimulates them to make cortisol. If the pituitary gland does not make enough ACTH, the body will have low levels of cortisol.

Causes of Adrenal Insufficiency

The cause of adrenal insufficiency is determined by the mechanism of the disease. The majority of cases of primary adrenal insufficiency, or Addison’s disease, are caused by an autoimmune disease. When this happens, the body’s immune system attacks its own cells, tissues, and organs, damaging the adrenal glands and inhibiting them from producing cortisol. Other causes of Addison’s disease include:

  • Viral and bacterial Infections, such as tuberculosis
  • Tumor in the adrenal glands
  • Bleeding in the adrenal glands

Secondary adrenal insufficiency is caused by complications in the pituitary gland that cause a lack of adrenocorticotropin (ACTH) or corticotropin-releasing hormone (CRH). These hormones are responsible for signaling for the production of cortisol. Without these hormones, the pituitary gland will not be stimulated to make cortisol, and the body will become deficient.

Symptoms of Adrenal Insufficiency

Symptoms of adrenal insufficiency can develop gradually and may go unnoticed until a stressful event.

Some of the most commonly experienced symptoms of adrenal insufficiency include:

  • Chronic fatigue
  • Loss of appetite
  • Muscle weakness
  • Weight loss

Other signs and symptoms associated with adrenal insufficiency include:

  • Nausea and/or vomiting
  • Diarrhea
  • Abdominal pain
  • Muscle and/or joint pain
  • Low blood pressure
  • Change in mood, such as depression or irritability
  • Low blood sugar (hypoglycemia)
  • Darkening of the skin (hyperpigmentation), most visible on scars and skin folds
  • In women, irregular menstruation

Call a doctor if you notice signs and symptoms of adrenal insufficiency. A healthcare professional will be able to tell you if your symptoms are the result of adrenal insufficiency or another medical condition.

What to Expect at Your Appointment

During your appointment, your doctor will ask you questions regarding your symptoms as well as your medical history. If your doctor suspects adrenal insufficiency, he/she will prescribe one or more of the following tests in order to make a diagnosis:

  • Blood test - Using a blood sample, your doctor will analyze the levels of sodium, potassium, ACTH, and cortisol in the blood. These levels may indicate whether an adrenal insufficiency may be the cause of the symptoms. A blood test can also be used to identify antibodies associated with an adrenal insufficiency caused by autoimmune disease.
  • ACTH stimulation test - This test is performed to measure the body’s response to the hormone ACTH, whether it will produce cortisol or not. During this test, patients will be given an injection of synthetic ACTH. A blood sample will be taken before and after the injection to measure levels of cortisol in the blood. Little to no change in cortisol levels after the ACTH injection indicates damage in the adrenal glands.
  • CRH stimulation test - If the results of an ACTH test are normal, a CRH stimulation test may be prescribed. During this test, individuals will be given an injection of synthetic CRH hormone. Blood samples will be taken before and after the injection in order to measure the levels of ACTH and cortisol in the blood. High levels of ACTH accompanied by no cortisol may indicate Addison’s disease. Low levels or no ACTH indicate secondary adrenal insufficiency.
  • Imaging tests - An MRI or CT scan may be prescribed in order to see any changes in the size of the pituitary gland or any abnormalities that may be contributing to the onset of symptoms.

Non-surgical Treatments for Adrenal Insufficiency

The goal of adrenal insufficiency treatment is to achieve a daily hormone balance in the body. This is done by replacing the hormones that the adrenal glands are unable to make.

Certain situations, like surgery, pregnancy, illness, and severe injury may place individuals at an increased stress level. These individuals may need extra care and additional treatment in order to recover from adrenal insufficiency. It is important to communicate with all healthcare providers in order to receive a treatment plan that is tailored specifically to one’s current life situation and the specific diagnosis.

Surgical Treatment for Adrenal Insufficiency and Post-Treatment

There are no surgical treatments for adrenal sufficiency.

Outlook and Prognosis for Individuals With Adrenal Insufficiency

If treated properly, individuals with adrenal insufficiency can live long, healthy, and active lives. As with any chronic condition, in order to avoid serious health complications, it is important to responsibly self-manage the condition, which involves taking medications as prescribed and working with physicians to adjust medications as needed. Proper treatment for adrenal insufficiency requires comprehensive care from adrenal experts. Seeking care for adrenal insufficiency in a multidisciplinary clinic such as MedStar Washington Hospital Center provides significant advantages to patients.

"The MedStar Pituitary Center brings together various subspecialists involved in the care of patients with pituitary disorders under one roof to be able to come up with a comprehensive, individualized treatment plan while making the experience more convenient for the patient." - Dr. Susmeeta Tewari Sharma, Director of Pituitary Endocrinology at the Dr. Susmeeta Tewari Sharma