The adrenal glands located on top of our kidneys, make hormones that are essential for body functions. The outer layer (cortex) of the adrenal glands makes three types of steroid hormones. In adrenal insufficiency, the cortex does not make enough steroid hormones.
There are two kinds of adrenal insufficiency:
- Primary – also called Addison’s Disease. In this condition, the adrenal glands do not work properly and cannot make enough cortisol. Usually, production of aldosterone and androgens(the other 2 hormones made by the adrenals) are also low.
- Secondary – results when the pituitary gland in the brain does not signal the adrenal glands to make cortisol.
The three adrenal hormones are:
- Cortisol, helps the body cope with stress, illness and injury. It also regulates blood glucose and blood pressure levels.
- Aldosterone, helps keep a proper balance of salt and water in the body. It also helps regulate blood volume and blood pressure.
- Adrenal androgens (sex hormones), help regulate hair growth in men.
The adrenal glands do not get “adrenal fatigue” or lose function because of mental or physical stress. True adrenal insufficiency is a serious, but rare health problem.
The most common cause of Primary Adrenal Insufficiency, is autoimmune disease. Other causes include bleeding in the glands, infections, and surgical removal of the glands.
Problems with the pituitary gland cause Secondary Adrenal Insufficiency. Normally, the pituitary gland makes a hormone called ACTH, which tells the adrenal glands to make cortisol. In Secondary Adrenal Insufficiency, the pituitary gland does not send ACTH to the adrenal glands, and thus no cortisol is made.
Some causes can be temporary, such as taking certain prescription medicines like prednisone, hydrocortisone, or dexamethasone. Other causes can be permanent such as tumors or infections in the pituitary, or surgical or radiation damage to the pituitary.
The symptoms of Adrenal Insufficiency, begin little by little. They include fatigue, muscle weakness, decreased appetite, and weight loss. Some people experience nausea, vomiting and diarrhea. Others symptoms include: pains in the muscles and joints, low blood pressure leading to dizziness upon standing, cravings for salt, symptoms of low blood glucose, and darkened skin in certain areas of the body (in Primary Adrenal Insufficiency).
Adrenal Insufficiency is diagnosed by an Endocrinologist after obtaining a very detailed medical history, and review of symptoms. The doctor will then check blood levels of cortisol, sodium and potassium. The doctor will also look at the adrenal glands or the pituitary gland with imaging tests, such as ultrasounds, CT or MRI scans.
The goal of treatment is to ensure proper hormone levels day to day. One may need daily replacement of hormones for life. You will take cortisol in pill form to replace the cortisol your body no longer makes. You may need aldosterone in pill form if your body no longer makes that as well.
Extra cortisol may be needed during times of stress, such as serious illness or surgery. Your Endocrinologist will provide personalized advice on adjusting your medicine in response to stress.