Adrenal Gland Insufficiency
What is adrenal gland insufficiency?
Adrenal gland insufficiency occurs when the adrenal gland does not produce one or more hormones if the pituitary gland is not working properly and fails to stimulate the adrenal glands to produce enough cortisol.
Anatomy
The adrenal glands are located above the kidneys. They produce many hormones, including aldosterone, glucocorticoids, androgens, and catecholamines (adrenaline), which help the body manage stress and regulate mineral and water balance, blood pressure, and glucose metabolism. The adrenal cortex does not produce enough cortisol (glucocorticoid), aldosterone (mineralocorticoid), and androgens in adrenal insufficiency.
Types of adrenal insufficiency
What is primary adrenal gland insufficiency?
Primary adrenal gland insufficiency occurs when the adrenal gland itself does not produce one or more hormones.
What are the causes of primary adrenal insufficiency?
- Autoimmune is the most common cause of adrenal insufficiency. The body’s defense system attacks and destroys the body’s tissues.
- Damage to the adrenal glands. This can occur due to bleeding in the glands, infections, genetic (inherited) diseases, and surgical removal of the adrenal glands.
Secondary Adrenal insufficiency occurs due to pituitary gland dysfunction, resulting in decreased production of ACTH, which in turn cannot stimulate the adrenal glands to produce enough cortisol.
What are the causes of secondary adrenal insufficiency?
- Medications – Prednisone, Hydrocortisone and Dexamethasone
- Damage to the pituitary – pituitary tumors compressing the normal pituitary gland, surgery, or radiation damage to the pituitary.
What are the symptoms and signs of adrenal insufficiency?
People with adrenal insufficiency may experience one or more of the following symptoms:
- Fatigue, muscle weakness
- Lightheadedness, dizziness
- Nausea and vomiting with or without abdominal pain or loose stools.
- Decreased appetite.
- Pain in the muscles and joints,
- An intense craving for salt
- Symptoms of low blood glucose, such as sweating (more common in children with AI)
- Irregular menstrual cycles in women.
People with adrenal insufficiency, especially primary adrenal insufficiency, may present with one or more of the following signs:
- Dehydration
- Low blood pressure
- Darkened skin on the face, neck, undersurface of the tongue, and back of the hands.
An adrenal crisis occurs when a person experiences the sudden onset of new or worsening symptoms of adrenal insufficiency—severe nausea and vomiting, abdominal pain, low blood pressure, dehydration, and confusion. This is precipitated by physical stress caused by illness, infection, surgery, or an accident.
People in adrenal crisis need an injection (shot) of glucocorticoids (medicines that replace cortisol) immediately and need to go to the hospital immediately for further management.
How is adrenal gland insufficiency diagnosed?
A good clinical degree of suspicion is required to make the diagnosis promptly. Many patients are diagnosed late and may present to the hospital with an adrenal crisis.
Dr Thomas will do a comprehensive medical evaluation during your consultation. She will order the appropriate blood test which will include a metabolic panel and hormone profile. If needed, she will arrange for you to have the appropriate radiology tests like CT scan of the pituitary or adrenal glands.
The goal of treatment is to ensure optimal replacement of the hormones that are not produced by the adrenal gland.
How is adrenal gland insufficiency treated?
A good clinical degree of suspicion is required to make the diagnosis promptly. Many patients are diagnosed late and may present to the hospital with an adrenal crisis.
Dr Thomas will do a comprehensive medical evaluation during your consultation. She will order the appropriate blood test, including a metabolic panel and hormone profile. If needed, she will arrange for you to have the appropriate radiology tests, like a pituitary or adrenal glands CT scan.
The goal of treatment is to ensure optimal replacement of the hormones not produced by the adrenal gland.
At a Glance
Dr. Reena Thomas, MD
- Dual American board-certified endocrinologist
- Author of numerous academic and clinic research
- Learn more
