What is the most common cause of adrenal insufficiency?

Primary adrenal insufficiency is most often caused when your immune system attacks your healthy adrenal glands by mistake. Other causes may include: Cancer. Fungal infections.

hopkinsmedicine.org - Adrenal Insufficiency (Addison's Disease) - Johns Hopkins Medicine

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Adrenal insufficiency occurs when the adrenal glands don’t make enough of the hormone cortisol. You have two adrenal glands. They are located just above the kidneys. They work with the hypothalamus and pituitary glands in the brain. Cortisol helps break down fats, proteins, and carbohydrates in your body. It also controls blood pressure and affects how your immune system works. Primary adrenal insufficiency. This is known as Addison's disease. It occurs when the adrenal glands are damaged. They don’t make enough of the hormones cortisol and aldosterone. This condition is rare. It may occur at any age. Secondary adrenal insufficiency. This starts when the pituitary gland doesn’t make enough of the hormone ACTH (adrenocorticotropin). As a result the adrenal glands don’t make enough cortisol.

What causes adrenal insufficiency?

Primary adrenal insufficiency is most often caused when your immune system attacks your healthy adrenal glands by mistake. Other causes may include:

Cancer

Fungal infections

Tuberculosis infection of the adrenal glands

Inherited disorders of the endocrine glands

A lack of the hormone ACTH leads to secondary adrenal insufficiency. That can happen if you must take certain steroids for a long time due to a health problem. For example, people with asthma or rheumatoid arthritis may need to take prednisone. Other causes include:

Pituitary gland tumors

Loss of blood flow to the pituitary

Pituitary gland is removed or you have radiation treatment of the pituitary gland

Parts of the hypothalamus are removed

What are the symptoms of adrenal insufficiency?

You may have mild symptoms when you are under physical stress. Each person’s symptoms will vary. Symptoms may include:

Weakness

Fatigue

Dizziness

Weight loss

Fluid loss (dehydration)

Lack of appetite

Muscle aches

Upset stomach (nausea)

Vomiting

Diarrhea

Low blood pressure

Low sugar levels

In women, irregular or no menstrual periods

If not treated, adrenal insufficiency may lead to:

Severe belly (abdominal) pain

Extreme weakness

Low blood pressure

Kidney failure

Shock

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is adrenal insufficiency diagnosed?

Your healthcare provider will ask about your medical history. You will also need an exam. Tests that can diagnose adrenal insufficiency include: Blood and urine tests. These can check levels of the adrenal hormones and ACTH.

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Imaging tests. These include X-rays, ultrasound, and MRI.

How is adrenal insufficiency treated?

Your healthcare provider will figure out the best treatment for you based on:

Your age, overall health, and past health

How sick you are

How well you can handle certain medicines, procedures, or therapies

How long the condition is expected to last

Your opinion or preference

You will need to take hormones to replace those that your adrenal glands are not making. That mainly means cortisol. But if you have Addison's disease, you may need to take aldosterone as well. Addison's disease can be deadly. Treatment often starts with IV (intravenous) fluids and medicines called corticosteroids. You may take these medicines by mouth or by IV. You may have to take them for the rest of your life. You may also need to take other medicines (fludrocortisones). These can help keep your body's sodium and potassium levels normal.

What are the complications of adrenal insufficiency?

You may have sudden severe symptoms. This is called acute adrenal insufficiency, or Addisonian crisis. This can occur when your body is stressed. That can happen for many reasons, such as an illness, fever, surgery, or dehydration. You may also have a crisis if you stop taking your steroids or lower the amount of your steroids suddenly. The symptoms of an Addisonian crisis include the symptoms of adrenal insufficiency or Addison’s disease. But if an Addisonian crisis is not treated, it can lead to:

Shock

Seizures

Coma

Living with adrenal insufficiency

Take your medicine exactly as prescribed. You should also carry a medical alert card or tag at all times. This can make sure you get proper treatment if there is an emergency. When traveling always carry an emergency kit with a shot of cortisol.

When should I call my healthcare provider?

Any condition that stresses your body can affect how much medicine you need. Call your healthcare provider if:

You have any kind of illness, especially a fever, vomiting, or diarrhea

You become pregnant

You need surgery

Key points about adrenal insufficiency (Addison’s disease)

hopkinsmedicine.org - Adrenal Insufficiency (Addison's Disease) - Johns Hopkins Medicine

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