Chronic Adrenal Insufficiency Symptoms, Causes & Treatment Options

A variety of conditions can cause chronic adrenal insufficiency, which is when the adrenal glands fail to produce hormones that are essential for life. Affected individuals must typically take medicine to replace the missing hormones.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Chronic Adrenal Insufficiency?

Summary

Chronic adrenal insufficiency is a life-threatening condition where the adrenal glands (tiny structures that sit atop the kidneys) fail to produce hormones such as cortisol and aldosterone. This can be caused by a failure of the glands themselves (primary adrenal insufficiency), failure of the pituitary gland in the brain to signal the adrenals to work (secondary adrenal insufficiency), or failure for the brain to signal the pituitary gland to work (tertiary adrenal insufficiency). A complete deficiency of cortisol or aldosterone hormones is incompatible with life, and the missing hormones must be replaced with oral steroids. The main symptoms of the disease are low blood pressure, dehydration, weight loss, and fatigue.

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Chronic Adrenal Insufficiency Symptoms

Main symptoms

The main symptoms of adrenal insufficiency include:

  • Weakness
  • Feeling tired
  • Dizziness
  • Unintentional weight loss
  • Dehydration
  • Low appetite
  • Muscle pain
  • Decreased libido
  • Nausea/vomiting
  • Diarrhea
  • Irregular (or no) period

Other symptoms

When adrenal insufficiency is untreated, it can result in adrenal crisis, which is defined by the following symptoms:

  • Low blood pressure
  • Loss of consciousness
  • Extreme weakness
  • Kidney failure
  • Severe belly pain
  • Death

Symptoms specific to Addison’s Disease

If Addison’s Disease is the cause for your adrenal insufficiency, you may also experience these specific symptoms:

  • Dark discoloration of skin
  • Blue / black discolorations: This particularly affects the skin of the mouth, scrotum, vagina, rectum, and nipples.

Chronic Adrenal Insufficiency Causes

The disease typically presents between the ages of 30 and 50 years, although it can occur at any time. The symptoms of chronic adrenal insufficiency are caused by insufficient levels of cortisol and aldosterone in your blood. These hormones are essential to life because they control basic functions such as blood sugar, body fluid, and blood pressure. These hormones are produced by the adrenal glands under normal circumstances. The adrenal glands are small structures that sit above the kidneys. There are a number of reasons that the adrenal glands may cease to function, and these are broken down into three categories called primary, secondary, and tertiary adrenal insufficiency. The causes of each type of adrenal insufficiency are listed below.

Primary Adrenal Insufficiency

Primary adrenal insufficiency is also known as Addison’s Disease. Addison’s disease can be caused by the following conditions:

  • Autoimmune disease: The body’s own immune system mistakenly attacks the adrenal glands. This is the most common cause of adrenal insufficiency.
  • Cancer that metastasizes to the adrenal gland
  • Tuberculous or fungal infection that metastasize to the adrenal gland
  • Adrenoleukodystrophy: an inherited disorder of the adrenal glands

Secondary Adrenal Insufficiency

In this category, the adrenal gland functions normally, but the signal from the pituitary gland in the brain to the adrenal gland is absent. The causes for secondary disease include:

  • Pituitary adenoma
  • Dysfunctional pituitary gland: can be due to tumor, infection, or hemorrhage (bleeding into the adrenal gland)
  • Trauma to the head

Tertiary Adrenal Insufficiency

Tertiary adrenal insufficiency is caused by a loss of the signal from the brain to the pituitary gland, which, in turn, fail to signal the adrenal glands to make the required hormones. The causes of tertiary adrenal insufficiency include:

  • Recent abrupt discontinuation of steroids
  • Tumors of the brain

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Treatment Options, Relief, and Prevention for Chronic Adrenal Insufficiency

Treatment

The diagnosis of adrenal insufficiency is relatively straightforward. Your doctor can test your blood for cortisol and aldosterone. A deficiency of cortisol and/or aldosterone is diagnostic of adrenal insufficiency. The adrenal insufficiency may be temporary or may be long term (chronic) depending on your medical history.

If you have a deficiency of cortisol/aldosterone, your adrenocorticotropic hormone (ACTH) level can be determined in later blood tests. This test indicates whether or not your pituitary gland is properly signaling to your adrenals to produce hormones. To verify that the adrenal glands are working appropriately, they can be stimulated to produce hormones using a manmade version of ACTH, called cosyntropin. Finally, you may receive imaging of your brain to see if the structure of your pituitary gland is normal.

The treatment for adrenal insufficiency centers around the replacement of the deficient cortisol and/or aldosterone. The following medications may be used:

  • Hydrocortisone: used to replace cortisone
  • Prednisone: used to replace cortisone
  • Methylprednisolone (Solu-Medrol): used to replace cortisone
  • Fludrocortisone (Florinef): used to replace aldosterone

It is very important to take your medications as prescribed. A complete deficiency of cortisol or aldosterone can lead to adrenal crisis, which is life-threatening. Moreover, if you become sick, receive surgery, or undergo significant stress, you will need to increase the dosage of your medication at the guidance of your provider because your adrenal glands will not be able to respond to the stress on their own.

In addition to the above medications, you will also need to eat sufficient salt in your diet especially if you sweat or lose fluid through diarrhea. You may need to use salt pills.

Prevention

There are limited ways to prevent adrenal insufficiency since it is most often caused by the unpreventable immune system attack of your adrenal glands. However, the following strategies may decrease the overall risk of developing adrenal insufficiency:

  • Treat fungal infections and tuberculosis
  • Do not abruptly stop steroid medication: Instead, prolonged steroid use should always be tapered off slowly at the guidance of a provider.

To prevent the development of adrenal crisis (a life-threatening condition where there is no cortisol hormone), you should always keep extra steroid medications on hand for an emergency. You should also carry an emergency steroid injection kit in case you cannot swallow pills due to nausea/vomiting. It is wise to carry a medical alert bracelet and card to alert any healthcare providers that you have adrenal insufficiency and may need emergency hormones.

When to Seek Further Consultation for Chronic Adrenal Insufficiency

If you feel the symptoms or have a persistently low blood pressure as outlined in the Symptoms section, you should see a doctor for workup of your blood to see if you have sufficient levels of cortisol and aldosterone.

If you have adrenal insufficiency and you run out of steroid medication, are vomiting and cannot take medication, or become sick, stressed, or injured, you must seek medical attention right away, including going to an emergency room in a hospital. Failure to seek immediate medical attention can cause adrenal crisis, which is a life-threatening condition in which you may need emergency hormone replacement.