Adrenal Insufficiency
What is Adrenal Insufficiency?
Adrenal insufficiency is a condition where your adrenal glands cannot produce enough essential hormones. The adrenal glands are small organs that sit on top of your kidneys. They make hormones that control energy, blood pressure, stress response, and metabolism.
The most important hormone affected is cortisol. Cortisol helps your body respond to stress and illness. It also regulates blood sugar and blood pressure. When your body lacks cortisol, you may feel constantly tired and weak. Other hormones affected include aldosterone, DHEA, and epinephrine.
There are two main types of adrenal insufficiency. Primary adrenal insufficiency is also called Addison's disease. This happens when the adrenal glands themselves are damaged. Secondary adrenal insufficiency occurs when the pituitary gland in your brain does not signal the adrenals properly. Both types can cause serious health problems if left untreated.
Symptoms
- Extreme fatigue and weakness that gets worse over time
- Unexplained weight loss and decreased appetite
- Low blood pressure that drops further when you stand up
- Darkening of the skin, especially on scars, skin folds, and pressure points
- Muscle aches and joint pain throughout the body
- Nausea, vomiting, and stomach pain
- Craving salty foods
- Dizziness or fainting when standing
- Mood changes including irritability and depression
- Low blood sugar levels
Some people have mild symptoms for months before they realize something is wrong. Symptoms often develop slowly and may be mistaken for other conditions. During times of physical stress like illness or injury, symptoms can become severe very quickly.
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Causes and risk factors
Primary adrenal insufficiency happens when the adrenal glands are damaged and cannot produce enough hormones. The most common cause is an autoimmune disease where your immune system attacks your adrenal glands. Tuberculosis and other infections can also damage the adrenal glands. Rarely, cancer, bleeding into the adrenal glands, or genetic conditions cause this type.
Secondary adrenal insufficiency is more common and occurs when the pituitary gland does not produce enough ACTH hormone. ACTH tells your adrenal glands to make cortisol. Long-term use of steroid medications is the most frequent cause. When you take steroids for conditions like asthma or arthritis, your pituitary gland stops signaling properly. Tumors, surgery, or radiation to the pituitary gland can also trigger this condition. Stopping steroid medication too quickly without medical supervision increases your risk.
How it's diagnosed
Diagnosing adrenal insufficiency requires blood tests that measure hormone levels. Your doctor will check your cortisol levels, especially in the morning when they should be highest. Tests for DHEA, DHEA-S, aldosterone, and other adrenal hormones help create a clear picture. An ACTH stimulation test may be ordered to see how your adrenal glands respond to signals.
Rite Aid offers testing for key adrenal hormones including cortisol, DHEA, DHEA-S, aldosterone, and pregnenolone. Our flagship panel includes over 200 biomarkers that can help identify hormone imbalances early. Testing twice per year helps you and your doctor monitor your adrenal function over time. Early detection allows for better management and prevents serious complications.
Treatment options
- Hormone replacement therapy with hydrocortisone or prednisone to replace missing cortisol
- Fludrocortisone medication to replace aldosterone in primary adrenal insufficiency
- Increasing medication doses during illness, injury, or surgery to match stress levels
- Eating regular meals with adequate protein and salt to maintain blood sugar and blood pressure
- Carrying emergency injection medication in case of adrenal crisis
- Wearing medical alert identification that lists your condition
- Working closely with an endocrinologist who specializes in hormone disorders
- Monitoring vitamin B5 levels as this nutrient supports adrenal function
- Avoiding situations that can trigger dangerously low cortisol levels
- Regular blood tests to ensure medication doses are appropriate
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- Simple blood draw at your nearest lab
- Results in days, not weeks
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Frequently asked questions
Primary adrenal insufficiency means the adrenal glands themselves are damaged and cannot produce hormones. This is also called Addison's disease. Secondary adrenal insufficiency means the pituitary gland in your brain is not sending proper signals to your adrenal glands. Both types cause low cortisol levels but have different underlying causes and may require different treatment approaches.
Most cases of adrenal insufficiency cannot be cured but can be managed successfully with daily medication. You will need to take hormone replacement therapy for life to replace the missing cortisol. With proper treatment, most people with this condition can live normal, active lives. The key is working closely with your doctor and never stopping your medication without medical supervision.
An adrenal crisis is a life-threatening emergency that happens when cortisol levels drop dangerously low. Symptoms include severe vomiting, diarrhea, dehydration, low blood pressure, confusion, and loss of consciousness. This can occur during illness, injury, or extreme stress if medication doses are not increased. An adrenal crisis requires immediate emergency medical treatment with intravenous steroids and fluids.
If you have been diagnosed with adrenal insufficiency, your doctor will recommend regular blood tests to monitor your hormone levels. Testing every 3 to 6 months is common when first starting treatment or adjusting doses. Once your medication is stable, annual or biannual testing may be sufficient. Rite Aid offers testing twice per year to help you track your adrenal function over time.
Salt cravings happen because low aldosterone levels cause your body to lose too much sodium through urine. Aldosterone is a hormone made by the adrenal glands that helps regulate salt and water balance. When this hormone is deficient, your body tries to compensate by creating cravings for salty foods. People with primary adrenal insufficiency often need to add extra salt to their diet.
Yes, physical stress from illness, injury, surgery, or severe emotional stress can worsen symptoms significantly. Your body normally increases cortisol production during stressful times. When you have adrenal insufficiency, your body cannot make this extra cortisol. You may need to increase your medication dose during stressful periods to prevent an adrenal crisis.
Skin darkening occurs only in primary adrenal insufficiency or Addison's disease. When the adrenal glands fail, the pituitary gland produces more ACTH hormone to try to stimulate them. High ACTH levels also stimulate melanin production in your skin. This causes darkening, especially in areas exposed to friction like elbows, knees, knuckles, and skin folds.
No, these are completely different conditions. Adrenal insufficiency is a serious medical condition diagnosed with blood tests showing very low cortisol levels. Adrenal fatigue is not recognized as a medical diagnosis by endocrinologists. If you feel constantly tired, getting proper blood testing can determine if you have true adrenal insufficiency or another underlying condition.
Yes, most people with well-managed adrenal insufficiency can exercise safely. However, you may need to adjust your medication dose on days with intense physical activity. Start slowly and pay attention to how your body responds. Carry emergency medication with you and make sure someone knows about your condition in case you need help.
Steroid medications like prednisone, dexamethasone, and hydrocortisone are the most common cause. These drugs are used to treat asthma, arthritis, inflammatory bowel disease, and autoimmune conditions. Taking steroids for more than 2 to 3 weeks can suppress your natural cortisol production. Never stop taking steroid medication suddenly, as this can cause a dangerous adrenal crisis.