Adrenal Insufficiency 101

What is Adrenal Insufficiency?

Adrenal insufficiency (AI) occurs when the body is unable to produce Cortisol, a hormone which helps maintain essential functions such as blood pressure, blood sugar, and heart muscle tone. There are over sixty causes of AI, including genetic mutations, autoimmune disease, infections, and steroid treatment for other conditions such as asthma and cancer. Some AI patients also have an Aldosterone deficiency making electrolyte balance an important part of managing adrenal insufficiency.

Adrenal Insufficiency affects children and adults of all races and ethnic backgrounds. There are different types and severities of adrenal insufficiency caused by a variety of conditions.

The treatment and management of adrenal insufficiency requires an individualized plan between patient and physician. Overall health, history, and other conditions need to be considered. Information pertaining to adrenal insufficiency management provided by our website is not meant to replace guided care from your medical providers.

Visit the National Institutes of Health for more detailed information on adrenal insufficiency.

What is Cortisol?

Information from the National Institutes of Health

“Cortisol belongs to the class of hormones called glucocorticoids, which affect almost every organ and tissue in the body. Cortisol’s most important job is to help the body respond to stress. Among its many tasks, cortisol helps

maintain blood pressure and heart and blood vessel function
slow the immune system’s inflammatory response—how the body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful
regulate metabolism

The amount of cortisol produced by the adrenal glands is precisely balanced. Like many other hormones, cortisol is regulated by the hypothalamus, which is a part of the brain, and the pituitary gland. First, the hypothalamus releases a “trigger” hormone called corticotropin-releasing hormone (CRH), which signals the pituitary gland to send out ACTH. ACTH stimulates the adrenal glands to produce cortisol. Cortisol then signals back to both the pituitary gland and hypothalamus to decrease these trigger hormones.” NIH

What is Aldosterone?

Information from the National Institutes of Health

“Aldosterone belongs to the class of hormones called mineralocorticoids, also produced by the adrenal glands. Aldosterone helps maintain blood pressure and the balance of sodium and potassium in the blood. When aldosterone production falls too low, the body loses too much sodium and retains too much potassium.

The decrease of sodium in the blood can lead to a drop in both blood volume—the amount of fluid in the blood—and blood pressure. Too little sodium in the body also can cause a condition called hyponatremia. Symptoms of hyponatremia include feeling confused and fatigued and having muscle twitches and seizures.

Too much potassium in the body can lead to a condition called hyperkalemia. Hyperkalemia may have no symptoms; however, it can cause irregular heartbeat, nausea, and a slow, weak, or an irregular pulse.” NIH

Types of Adrenal Insufficiency

Information compiled by AIU using sources from the Lancet 2014 “Adrenal Insufficiency”: Evangelia Charmandari, Nicolas C Nicolaides, George P Chrousos. Additional resources from NIH and Mayo Clinic were also used. Reviewed and edited by Dr. Mitchell Geffner.

Primary Adrenal insufficiency

PAI occurs due to abnormalities of the outer portion of the adrenal glands known as the cortex. In primary AI, production of both cortisol and aldosterone is dampened. ACTH levels are elevated as the pituitary gland tries to correct the AI. Some causes of primary AI include: Addison’s Disease (autoimmune adrenalitis), Congenital Adrenal Hyperplasia, Adrenoleukodystrophy, IMAGe syndrome, Adrenal Hypoplasia Congenita

Central Adrenal Insufficiency

Central Adrenal Insufficiency encompasses pituitary (secondary) and hypothalamic (tertiary) causes. Corticotropin-releasing hormone (CRH) is the hypothalamic (brain) hormone that causes the pituitary gland to secrete the hormone, ACTH which, in turn, tells the outer part of the adrenal gland to produce cortisol

Secondary Adrenal Insufficiency

Secondary adrenal insufficiency (SAI) occurs due to damage of the pituitary gland. Morning ACTH levels are generally low in this setting.  Some causes of secondary AI include: Pituitary tumors, Mutations in pituitary transcription factors causing multiple pituitary hormone deficiencies and rarely isolated ACTH deficiency, Sheehan syndrome (pituitary infarction), Trauma, and Iron deposition.

Tertiary Adrenal Insufficiency

Tertiary adrenal insufficiency occurs due to problems with the hypothalamus. Tests may show low-to-normal morning ACTH levels. Some causes of tertiary AI include: Use of glucocorticoids, Hypothalamic tumors, Hypothalamic hypopituitarism, Following cure of Cushing syndrome, Trauma. Iron deposition.

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What are the symptoms of Adrenal Insufficiency?

chronic, or long lasting, fatigue
muscle weakness
loss of appetite
weight loss
abdominal pain
painful muscles and/or join pain
prolonged recovery from minor infections
nausea
vomiting
diarrhea
low blood pressure that drops further when a person stands up, causing dizziness or fainting
irritability and depression
craving salty foods
hypoglycemia, or low blood sugar
headache
sweating
darkening of the skin
irregular or absent menstrual periods

Once diagnosed, health can improve dramatically as you can see from the photos of Anastasia. However, adrenal insufficiency is a chronic condition that can pose many challenges. Although they may look “normal” those with adrenal insufficiency often suffer from symptoms that seem invisible to coworkers, family and friends.

Adrenal Crisis 911

An Acute Adrenal Crisis sometimes called an (Addisonian crisis) is a life threatening emergency and must be treated aggressively.

During times of illness or injury the body naturally produces extra cortisol to maintain normal functions such as fluid balance and blood pressure. Since those with adrenal insufficiency are unable to produce adequate levels of cortisol an additional dose of hydrocortisone is necessary. Without this extra dose an adrenal crisis causing shock, heart failure, coma and even death can occur.

Defined by UCLA Health

“Acute adrenal crisis is a MEDICAL EMERGENCY caused by a lack of cortisol. Patients may experience lightheadedness or dizziness, weakness, sweating, abdominal pain, nausea and vomiting, or even loss of consciousness. Risk factors for adrenal crisis include physical stress such as infection, dehydration, trauma, or surgery, adrenal gland or pituitary gland injury, and ending treatment with steroids such as prednisone or hydrocortisone too early.”