With adrenal insufficiency, your body doesn't produce enough of the stress hormones required to maintain everyday functions. One common cause of this is a condition known as Addison's disease. Addison's disease is an uncommon autoimmune disorder that affects 100 to 140 people in every million. In this article, we will discuss in detail what exactly adrenal insufficiency is, how it affects the body, and how to identify if you may be suffering from this disorder.
Adrenal insufficiency occurs when the adrenal glands don't produce enough hormones in stressful situations, such as adrenaline, cortisol, and aldosterone.
Symptoms of adrenal insufficiency include weakness, fatigue, abdominal pain, loss of appetite, nausea, and dehydration.
Treatment includes corticosteroids for cortisol replacement and fludrocortisone for aldosterone replacement.
Adrenal fatigue is different from adrenal insufficiency; it's caused by chronic stressors leading to overconsumption of hormones and is not medically treated.
An adrenal crisis can occur during extreme stress, illness, or injury and requires medical treatment at a hospital with injectable steroids; if signs or symptoms appear, seek help immediately.
What are adrenal glands?
You have two adrenal glands. Both are located on top of each kidney and help make different hormones in the body. The primary hormones they create are cortisol, aldosterone, and adrenaline. These hormones help the body manage stress, control blood pressure, and balance salt levels.
- Adrenaline. This is a hormone specifically created when you are stressed. Think "fight or flight." This hormone helps increase your heart rate and senses.
- Cortisol. This is a hormone that helps you deal with stress. It controls your blood pressure and immune system and puts sugar in the blood for energy.
- Aldosterone. This is a hormone that helps keep sodium and potassium in the body balanced, and it uses these electrolytes to balance fluid levels.
When the adrenal glands aren't producing enough hormones, it leads to adrenal insufficiency. These hormones are needed for essential functions, and without them can lead to fatigue, muscle weakness, weight loss, lack of appetite, and belly pain.
What is adrenal insufficiency?
Adrenal insufficiency is caused by the body's adrenal glands not making enough hormones. It is a disorder where the adrenal glands don't produce enough hormones in stressful situations, such as adrenaline, cortisol, and aldosterone.
These hormones are referred to as stress hormones, and they help to regulate the body to deal with all different types of stressors. When there are not enough of these hormones, it creates complications in the body.
Symptoms of adrenal insufficiency
Symptoms of adrenal insufficiency can include:
- Abdominal pain
- Loss of appetite
- Skin changes
To determine if you have adrenal insufficiency, your doctor will do blood tests to check your hormone levels. You may also receive an injection of a hormone stimulator to see how you respond. A magnetic resonance imaging (MRI) of your brain may also be ordered to see your pituitary gland, which sends signals to your adrenal glands.
What causes adrenal insufficiency?
There are three different types of adrenal insufficiency. One is when the adrenal glands do not produce enough hormones and another where the pituitary or hypothalamus gland in the brain doesn't have enough signal hormones to send to the adrenal glands.
- Primary adrenal insufficiency. This occurs when the adrenal glands are damaged or have a genetic problem and do not allow enough stress hormones to be produced. One of the most common causes of this type is Addison’s disease, which is an autoimmune condition where your body attacks its own adrenal glands.
- Secondary adrenal insufficiency. This occurs when the pituitary gland in the brain is not sending enough signal hormones (adrenocorticotropic hormone or ACTH) to the adrenal glands to make cortisol. Cysts or tumors on the pituitary gland are a common secondary cause of this condition.
- Tertiary adrenal insufficiency. This occurs when the hypothalamus gland, located in the brain, is not sending its signal hormone (corticotropin-releasing hormone or CRH) to the pituitary to produce ACTH.
There are several different causes and other conditions that can cause adrenal insufficiency. It is more common among women than it is among men and most commonly affects people around the age of 30 to 50 years old. It is possible for other age groups, such as children and the elderly, to have adrenal insufficiency but not as common.
Certain types of medication, like corticosteroids such as prednisone, can cause adrenal insufficiency when used in high doses and then stopped.
How is it treated?
When you have adrenal insufficiency or Addison’s disease, it is treated by giving replacement hormones and steroid-based medication.
- Corticosteroids. These include prednisone, and can be taken several times daily to replace cortisol levels.
- Fludrocortisone. This can also be taken to replace aldosterone and help improve the body's salt levels.
Adrenal fatigue vs. adrenal insufficiency
Adrenal fatigue is different than adrenal insufficiency.
In adrenal insufficiency, there is a lack of hormones created by the adrenal gland due to a medical complication, and hormone replacements will be needed to help.
Adrenal fatigue is caused by chronic stressors, including emotional, physical, and mental, leading to the overconsumption of hormones. Adrenal fatigue is not currently a recognized or medically treated condition.
Adrenal fatigue symptoms may include:
- Difficulty sleeping or waking up
- Salt and sugar cravings
- Brain fog
- Lack of motivation
Even though adrenal fatigue is not recognized as a medical condition, this does not mean your symptoms aren’t real. If you feel like you may have adrenal fatigue, see your doctor for a full workup to ensure nothing else is happening.
If you have chronic stressors in your life that could lead to symptoms of adrenal fatigue, then the best way to manage these symptoms is by taking steps to reduce the stress in your life. This can include adjusting your diet, exercising regularly, getting more restful sleep, and reducing or removing activities that can cause added stress.
What is an adrenal crisis?
Sometimes hormone levels with adrenal insufficiency can decrease despite treatment, especially during times of stress, illness, or injury. When this happens, symptoms can worsen and cause an adrenal crisis.
The lack of hormones in an adrenal crisis can cause severe complications leading to death. It can cause critically low blood pressure, blood glucose, and blood sodium levels. It can also cause extremely high potassium levels leading to dangerous heart dysrhythmias.
An adrenal crisis is a medical emergency and requires medical treatment at a hospital to receive intravenous (IV) doses of corticosteroids.
Symptoms of an adrenal crisis may include:
- Abdominal pain
- Perfuse sweating
- Loss of consciousness
People with adrenal insufficiency should wear a medical alert bracelet and have injectable steroids on them in case an adrenal crisis occurs.
When should I seek help?
If you notice signs and symptoms of an adrenal crisis, then take an injectable steroid if available and call 911. Adrenal crisis, if not treated, can cause severely low blood pressure, blood sugar, sodium levels, and increased potassium levels, which can lead to death.
If you are taking medications for adrenal insufficiency and are having trouble taking or accessing them, then call your doctor for help.
If you develop signs or symptoms of an infection, including fever, cough, diarrhea, or vomiting, then notify your doctor right away.
- National Institute of Diabetes and Digestive and Kidney Diseases. Adrenal Insufficiency and Addison’s Disease.
- National Institute of Diabetes and Digestive and Kidney Diseases. Definition and Facts of Adrenal Insufficiency & Addison's Disease.
- Nemours KidsHealth. Adrenal Insufficiency.