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Adrenal Insufficiency

Inadequate cortisol production due to dysfunction of the adrenal glands or pituitary control.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Adrenal Insufficiency?

Adrenal insufficiency is a condition in which the adrenal glands fail to produce sufficient cortisol (and aldosterone). In primary adrenal insufficiency (Addison's disease), the problem is directly in the adrenal gland, while in secondary adrenal insufficiency the pituitary's insufficient ACTH secretion fails to adequately stimulate the adrenal gland.

The most common cause of secondary adrenal insufficiency is sudden discontinuation of prolonged corticosteroid therapy; this suppresses the pituitary's ACTH production. Pituitary adenoma, trauma, radiotherapy, or inflammation can also cause secondary insufficiency.

In both forms, cortisol requirements increase during periods of stress (infection, surgery, injury); failure to produce sufficient hormone turns into adrenal crisis (acute adrenal insufficiency). Adrenal crisis is a medical emergency that can result in death and must be treated immediately with IV hydrocortisone.

Symptoms

Fatigue, weakness, and muscle pain
Low blood pressure and orthostatic dizziness
Nausea, vomiting, and abdominal pain
Weight loss and loss of appetite
Darkening of skin and mucous membranes in primary form (ACTH excess)
Tendency to hypoglycemia
Shock, fever, and loss of consciousness in adrenal crisis (emergency!)

Risk Factors

Long-term (>3 weeks) corticosteroid use and sudden discontinuation
Autoimmune diseases (for Addison's)
Pituitary tumor or surgery
Tuberculosis or fungal infection (can involve the adrenals)
HIV/AIDS
Those using anticoagulants (risk of adrenal hemorrhage)
Metastatic cancer

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Unexplained fatigue, low blood pressure, and weight loss together
  • If symptoms develop when corticosteroid therapy is being discontinued
  • Severe abdominal pain, vomiting, and altered consciousness (adrenal crisis — emergency!)
  • If cortisol response is insufficient on ACTH stimulation test
  • Fatigue and hypotension while being followed for pituitary disease

Treatment Methods

01
Hydrocortisone replacement: 15-25 mg daily in divided doses (with emphasis on morning)
02
Fludrocortisone (mineralocorticoid replacement in primary form)
03
Stress dose education: dose should be increased 2-3 fold in fever/illness
04
Emergency hydrocortisone injection kit (100 mg vial): should be taught to the patient and relatives
05
IV hydrocortisone 100 mg + saline infusion in adrenal crisis (emergency)
06
Carrying a medical ID card or bracelet

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.