Adrenal insufficiency

What is adrenal insufficiency?

Adrenal insufficiency (AI) can be caused either by primary failure of the adrenal glands (primary AI also known as Addison’ disease) or by secondary damage to the pituitary gland (secondary AI when the pituitary fails to signal the adrenals to make steroids). Primary adrenal insufficiency results in mineralocorticoid and glucocorticoid deficiencies that need to be replaced. Secondary adrenal insufficiency requires only glucocorticoid replacement. Causes of primary AI include autoimmune destruction of the adrenals, adrenal bleeding, infections, genetic causes, and surgical removal. Causes of secondary AI include steroid medications, pituitary tumors, or pituitary injury due to trauma, surgery, radiation or rapid blood loss.

What are the symptoms of adrenal insufficiency?

Symptoms of adrenal insufficiency (AI) include:

• Nausea, vomiting, diarrhea
• Decreased appetite and weight loss
• low blood pressure resulting in dizziness with standing or fainting
• low blood sugar resulting in sweating, lightheadedness, or fainting
• muscle weakness/pain or pain in the abdomen or legs
• dehydration and confusion
• skin darkening on the face and neck (primary AI)
• salt cravings (primary AI)

*When under stress, these symptoms can be more severe and can be life threatening

How is Adrenal Insufficiency diagnosed? 

The symptoms of adrenal insufficiency can be nonspecific, so it is important that accurate biochemical diagnosis is performed. Adrenal insufficiency is diagnosed with a cosyntropin stimulation test. This testing is typically done in the morning. Baseline ACTH and cortisol levels are drawn followed by an injection of cosyntropin which stimulates the adrenal glands. Cortisol levels are drawn again at 30 minutes and 60 minutes after the injection.  Imaging studies may also be needed to assess the anatomy of the adrenal glands or pituitary.

How is adrenal insufficiency (AI) treated?

Adrenal insufficiency (AI) is treated by replacing cortisol using glucocorticoids. Primary adrenal insufficiency patients will also need mineralocorticoid replacement. These will be needed for life, and often higher doses of glucocorticoids will be needed if you have surgery or similar stresses on your body. Because treatment is typically life long, it is vital that accurate diagnostic testing occur prior to starting replacement. 

How is adrenal fatigue treated?

It is very important to note that your adrenal glands cannot lose their function or get “adrenal fatigue” as a result of any mental of physical stress. While this term is commonly used by providers without Endocrinology training, there is no evidence that this can actually occur, has ever occurred, or that it can be treated. In fact in many cases, treatments are used by non-Endocrine providers that can result in harmful conditions to the patient. If you have been told that you have adrenal fatigue, please seek care with a board-certified Endocrinologist before starting any therapy. By contrast true adrenal insufficiency is a very serious health problem that should be accurately diagnosed and treated by an Endocrinologist. 

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