Secondary adrenal insufficiency
What is Secondary adrenal insufficiency?
Secondary adrenal insufficiency is a condition where your pituitary gland fails to produce enough ACTH. ACTH stands for adrenocorticotropic hormone. This hormone tells your adrenal glands to make cortisol.
When your pituitary gland doesn't make enough ACTH, your adrenal glands get weak signals. Your cortisol levels drop as a result. Cortisol is a hormone that helps your body respond to stress, maintain blood pressure, and regulate metabolism.
This condition is different from primary adrenal insufficiency, where the adrenal glands themselves are damaged. In secondary adrenal insufficiency, your adrenal glands are healthy. The problem starts in your pituitary gland or hypothalamus, which sits at the base of your brain.
Symptoms
- Extreme fatigue that doesn't improve with rest
- Muscle weakness and joint pain
- Loss of appetite and unintended weight loss
- Nausea, vomiting, and stomach pain
- Low blood pressure that causes dizziness when standing
- Low blood sugar levels, especially in children
- Headaches and confusion
- Irritability and depression
- Salt cravings
Some people have mild symptoms for months before seeking help. Others develop symptoms suddenly during times of stress or illness. Unlike primary adrenal insufficiency, skin darkening does not occur with this condition.
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Causes and risk factors
The most common cause of secondary adrenal insufficiency is long-term use of corticosteroid medications like prednisone. These medications are prescribed for conditions like asthma, arthritis, and autoimmune diseases. When you take these drugs for weeks or months, your pituitary gland stops making ACTH. Suddenly stopping the medication can trigger a crisis.
Other causes include pituitary tumors, pituitary surgery or radiation, traumatic brain injury, and infections affecting the pituitary gland. Sometimes blood flow problems or autoimmune conditions damage the pituitary gland. Rarely, the hypothalamus fails to produce the hormone that triggers ACTH release. People who take high doses of opioid pain medications for long periods also face increased risk.
How it's diagnosed
Doctors diagnose secondary adrenal insufficiency through blood tests that measure cortisol and ACTH levels. A morning cortisol test is often the first step, since cortisol levels are naturally highest in the morning. Low cortisol combined with low or normal ACTH suggests secondary adrenal insufficiency.
An ACTH stimulation test may be performed to confirm the diagnosis. During this test, synthetic ACTH is injected and cortisol levels are measured before and after. Additional testing may include insulin tolerance tests or CRH stimulation tests. Rite Aid offers ACTH and cortisol testing through our lab network at Quest Diagnostics locations nationwide. You can add specialized hormone testing to your preventive health panel.
Treatment options
- Hormone replacement therapy with hydrocortisone or other corticosteroid medications to replace missing cortisol
- Adjusting medication doses during illness, surgery, or times of physical stress
- Carrying an emergency injection of hydrocortisone for adrenal crisis situations
- Wearing a medical alert bracelet that identifies your condition
- Gradually tapering corticosteroid medications rather than stopping suddenly
- Eating regular meals to maintain stable blood sugar levels
- Increasing salt intake if blood pressure is low
- Working with an endocrinologist to monitor hormone levels regularly
- Managing underlying pituitary conditions through surgery, medication, or radiation when needed
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Frequently asked questions
Primary adrenal insufficiency occurs when the adrenal glands themselves are damaged and cannot produce cortisol. Secondary adrenal insufficiency happens when the pituitary gland fails to produce enough ACTH, the hormone that signals the adrenal glands. In secondary adrenal insufficiency, the adrenal glands are healthy but receive inadequate signals. People with primary adrenal insufficiency often develop skin darkening, while those with secondary adrenal insufficiency do not.
Some cases can be reversed if the underlying cause is treated. For example, if the condition is caused by corticosteroid medication use, slowly tapering off the medication may allow the pituitary gland to recover. This process can take months to over a year. If a pituitary tumor is removed, pituitary function may return. However, many people require lifelong hormone replacement therapy.
Symptoms can develop gradually over months or appear suddenly. People taking corticosteroid medications may not notice symptoms until they try to reduce or stop the medication. Symptoms often worsen during periods of physical stress, illness, or surgery. Some people have mild fatigue for months before other symptoms become noticeable.
An adrenal crisis can be triggered by physical stress such as infection, injury, surgery, or severe illness. Suddenly stopping corticosteroid medications is another common trigger. Vomiting or diarrhea that prevents medication absorption can also cause a crisis. During these times, your body needs more cortisol than usual but cannot produce it.
Testing frequency depends on your treatment plan and symptom stability. Most people need testing every 3 to 6 months initially after diagnosis. Once your hormone replacement dose is stable, annual testing may be sufficient. Your doctor may recommend more frequent testing if you change medications or experience new symptoms.
Yes, but you need to take precautions. Exercise is a form of physical stress that increases your body's cortisol needs. You may need to adjust your medication dose on days with intense physical activity. Start with gentle exercise and gradually increase intensity. Always carry your emergency hydrocortisone injection during workouts.
Take the missed dose as soon as you remember if it is within a few hours. If it is almost time for your next dose, take your regular dose and do not double up. Missing doses can cause symptoms to return or worsen. Contact your doctor if you miss multiple doses or feel unwell.
Eating regular meals helps maintain stable blood sugar levels, which is important since cortisol helps regulate glucose. Some people benefit from slightly increased salt intake to support blood pressure. Avoid fasting or skipping meals. Stay hydrated, especially during hot weather or exercise. A balanced diet with adequate protein supports overall health.
Many people with secondary adrenal insufficiency require lifelong treatment. However, some cases resolve if the underlying cause is corrected. For example, pituitary gland function may recover after a tumor is removed or after gradually stopping long-term corticosteroid use. Your doctor can test whether your pituitary gland has regained normal function over time.
Yes, pregnancy requires close monitoring and often increased medication doses. Cortisol needs increase during pregnancy, especially in the third trimester and during labor. Work with both your endocrinologist and obstetrician to adjust your treatment plan. With proper management, most women with this condition can have healthy pregnancies and deliveries.