Adrenal Insufficiency

Overview

Adrenal insufficiency – also known as Addison’s disease – is an uncommon condition that occurs when the body doesn’t produce enough of some hormones. Those with this condition produce too little cortisol and, often, too little aldosterone.

Sometimes a life-threatening condition, adrenal insufficiency can occur in both males and females and at any age. If you are diagnosed with adrenal insufficiency, your treatment will involve taking hormones to bring up your low levels of cortisol and/or aldosterone.

Adrenal insufficiency causes

Adrenal insufficiency is caused by damage to the adrenal glands, which occurs when the body doesn’t create enough cortisol or aldosterone. There are several reasons why the body doesn’t produce enough of these hormones. These include:

• Autoimmune conditions
• Genetic defects
• Tuberculosis

Adrenal insufficiency risk factors

Some researchers believe that a type of gene – called the human leukocyte antigen (HLA) complex – may affect a person’s risk for developing the disease. However, the genetic connection is still being researched.

Other conditions that may increase your risk for developing adrenal insufficiency are:

• Adrenalectomy (surgical removal of the adrenal glands)
• Amylioidosis (abnormal protein buildup in the body that can lead to serious complications)
• Cancer that has metastasized (spread) to the adrenal glands
• Certain fungal infections
• Genetic defect of the adrenal glands
• Hemorrhage (bleeding)
• Human immunodeficiency virus (HIV)

Adrenal insufficiency symptoms

The signs and symptoms of adrenal insufficiency typically come on slowly, usually over several months. Symptoms may include:

• Craving salt and salty foods
• Darkening of the skin
• Decreased appetite
• Depression
• Extreme tiredness
• Fainting
• Hypoglycemia (low blood sugar levels)
• Hypotension (low blood pressure)
• Loss of body hair
• Nausea, diarrhea or vomiting
• Pain in the abdomen
• Pain in the muscles or joints
• Sexual dysfunction (in women)
• Unexplained weight loss
• Unusual irritability

Adrenal insufficiency diagnosis

Your doctor may use a series of tests to diagnose adrenal insufficiency. You may undergo a blood test, which will check your blood levels of sodium, potassium, cortisol, adrenocorticotropic hormone (ACTH) and antibodies associated with the condition. You may also undergo imaging tests – such as computerized tomography (CT) or magnetic resonance imaging (MRI) – to check your adrenal or pituitary glands for abnormalities.

ACTH signals the adrenal glands to produce hormones. You may also undergo an ACTH stimulation test. In this test, you are given an injection of synthetic ACTH to see how your adrenal glands react.

Another diagnostic test you may undergo is an insulin-induced hypoglycemia test. In this test, the doctor checks your blood sugar and cortisol levels after you receive an insulin injection. What happens to these levels can help your doctor confirm whether the condition is present.

Adrenal insufficiency treatments

Nearly everyone who has adrenal insufficiency needs to take hormone replacement medication. The medications you may need to take include:

• Fludrocortisone, which replaces aldosterone in the body.
• Hydrocortisone, prednisone or methylprednisolone, which replaces cortisol in the body.

Other treatments for adrenal insufficiency can include these lifestyle adjustments:

• Carrying a glucocorticoid injection kit, which you can use in case of an emergency.
• Keeping extra medication handy so you don’t run out of critical medicines and can stay on your schedule.
• Staying in contact with your doctor and setting and keeping regular appointments to help monitor any changes related to your condition.

When to seek care

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing an endocrinologist for more specialized treatment.