Adrenal Insufficiency

Adrenal Insufficiency Overview

Your adrenal glands sit on top of your kidneys and produce vital hormones that help your body run smoothly. Two of the most important hormones are cortisol and aldosterone. Cortisol helps your body deal with stress, aids in controlling your blood sugar, regulates inflammation, and influences energy production. Aldosterone helps keep your blood pressure stable by managing salt and water balance.

Adrenal insufficiency is when your adrenal glands aren’t working correctly—they’re not producing enough cortisol to meet the body’s demands and, in some cases, not enough aldosterone. This can make you feel sluggish, less able to deal with physical and psychological stress, and in severe cases, lead to low blood pressure and dehydration.

Adrenal insufficiency comes in two main types:

1. Primary Adrenal Insufficiency: This is a problem directly related to your adrenal glands, which are either damaged (autoimmune diseases, infections, and bleeding) and do not produce enough cortisol and aldosterone, or removed surgically. Autoimmune diseases are conditions where your immune system mistakenly attacks the organs in your body, such as your adrenal glands.
2. Secondary Adrenal Insufficiency: This is when there is a problem not with the adrenal glands but with the hormones produced by the pituitary gland telling them to work. As a result, your adrenal glands do not get the message to produce sufficient amounts of cortisol to meet your body’s demands.

A lack of cortisol and aldosterone might make you feel exhausted and weak, lose weight without trying, cause low blood pressure, or even see your skin getting darker (in cases of primary adrenal insufficiency).

To determine what’s going on, your doctors can run tests to check hormone levels in your blood and see how well your adrenal glands respond to commands (with an ACTH stimulation test, for example). Treatment involves replacing these hormones with medications that act like cortisol and if needed, aldosterone, to help you feel better again.

People with adrenal insufficiency need to carry identification (like a medical alert bracelet) that lets others know about their condition in case of an emergency. Sometimes, your body needs more cortisol to deal with psychological stress or physical illness. In these circumstances, you will need to stress dose by increasing your steroid medications.

Proper management will allow you to live a healthy and active life despite having adrenal insufficiency.

About the Endocrine System

Your adrenal glands are part of your endocrine system, a highly coordinated and complex chemical messaging system within your body that is made up of specialized glands. These glands include the pituitary gland (often called the master gland), thyroid, parathyroid, adrenal glands, pancreas, and reproductive glands (ovaries in women and testes in men). These glands release chemical signals called hormones directly into the bloodstream.

Hormones are the body’s messaging molecules. They travel through the bloodstream to different body parts, delivering instructions to tissues and organs and helping regulate their function. These instructions can tell your body to grow, produce energy, respond to stress, and maintain a healthy balance of all bodily functions (homeostasis).

The master gland, the pituitary, plays a crucial role. Located at the base of your brain, it sends signals to other glands, telling them when to release their hormones. This system ensures that everything in your body works in harmony. For example, the thyroid gland controls your metabolism, the adrenal glands manage your stress response and blood pressure, and the pancreas regulates your blood sugar levels.

The endocrine system ensures messages are delivered at the right time, place, and amount. If something goes wrong within this system—for instance, if a gland produces too much or too little of a hormone—it can disrupt the balance, leading to various health issues, of which some can be serious.

Here’s a breakdown of the symptoms you might experience with adrenal insufficiency:

• Fatigue and Weakness: You might feel exhausted, almost like you’ve run a marathon when you haven’t. Even after a good night’s sleep, you could feel fatigued. Your muscles might feel weak, making daily tasks feel more strenuous.
• Weight Loss and Decreased Appetite: You might notice that you’re losing weight without trying. Along with this, your appetite might decrease, and you could find yourself eating less than usual.
• Low Blood Pressure: Your blood pressure may drop, making you feel dizzy or lightheaded, especially when you stand up from sitting or lying down. This happens because there’s insufficient aldosterone to keep your blood pressure normal.
• Salt Craving: Due to the low aldosterone levels, your body may lose more salt than it should, leading to cravings for salty foods.
• Low Blood Sugar: Since cortisol helps manage your blood sugar levels, not having enough can lead to hypoglycemia, especially in children. You might feel more irritable or shaky than usual.
• Nausea, Diarrhea, or Vomiting: Digestive issues are common, and you might find yourself feeling nauseous and experiencing bouts of diarrhea or vomiting.
• Skin Changes: In primary but not secondary adrenal insufficiency, areas of your skin and mucous membranes (like the inside of your mouth) may turn darker or more pigmented. This symptom is more specific to Addison’s disease, a type of primary adrenal insufficiency.
• Mood Changes: You might experience mood swings, depression, or irritability. The lack of cortisol can affect your emotional well-being.

These symptoms can initially be subtle and are often mistaken for signs of other illnesses. If you’re experiencing these symptoms, it’s essential to consult a healthcare provider who can perform tests to diagnose adrenal insufficiency. An accurate diagnosis will help you to manage the condition effectively, minimizing these symptoms and improving your quality of life.

The critical components of treatment include:

• Steroid Replacement: This is the cornerstone of treatment. Medications such as hydrocortisone, prednisone, or dexamethasone are used to replace cortisol, the hormone that your body is lacking. The specific medication and dose depend on your individual needs. Your doctor will adjust them to mimic the natural rhythm and amount of cortisol your body would typically produce.
• Mineralocorticoid Replacement: If you have primary adrenal insufficiency, your body may also lack aldosterone, another vital hormone the adrenal glands produce. In this case, you would be prescribed a medication called fludrocortisone to help maintain your body’s balance of salt and water, which is crucial for controlling blood pressure.
• Androgen Replacement: Some, but not all, women with adrenal insufficiency may benefit from androgen replacement therapy. DHEA (dehydroepiandrosterone) is a weak male hormone (androgen) produced by the adrenal glands. Supplementing with DHEA can help improve overall well-being, energy levels, and sex drive in some women.
• Adjusting Medication During Stress: It’s crucial to increase your steroid dosage during periods of stress, such as illness, surgery, or even severe emotional stress. Since your body would increase cortisol production in these situations, you must mimic this response by taking more steroids. Your doctor will guide you on adjusting your doses in these circumstances.
• Emergency Treatment: If you have adrenal insufficiency, you’re at risk of adrenal crisis, a life-threatening situation that requires immediate medical attention. Symptoms include severe vomiting, diarrhea, low blood pressure, and loss of consciousness. You should always carry a medical alert card or wear a medical alert bracelet that lets others know of your condition in an emergency. Injectable hydrocortisone should be kept on hand for such situations, and you and your loved ones should know how and when to use it. For more on adrenal crisis, please see below.
• Regular Monitoring: Regular follow-ups with your healthcare provider are essential. These appointments are crucial for monitoring your condition, adjusting medication as needed, and ensuring that you’re receiving the optimal treatment.

These treatments aim to keep your symptoms under control and prevent complications, enabling you to lead a healthy and active life. Your healthcare team will work closely with you to tailor your treatment plan to your needs and lifestyle.

Adrenal Crisis

Adrenal crisis is a serious and potentially life-threatening condition that occurs when your body is under severe stress, and your adrenal glands fail to produce enough cortisol to meet its demands. It’s most commonly seen in individuals with adrenal insufficiency, whose adrenal glands don’t make enough hormones under normal circumstances. The demand for cortisol spikes dramatically during periods of acute stress, such as illness, surgery, or severe injury. The body’s inability to meet this demand can lead to adrenal crisis.

The symptoms of an adrenal crisis can develop quickly and may include:

• Severe weakness
• Fatigue and confusion
• Abdominal pain (sometimes severe), vomiting, and diarrhea leading to dehydration
• Low blood pressure, causing dizziness or fainting
• Low blood sugar levels
• Fever
• Rapid heart rate

If you or someone you know with adrenal insufficiency begins to experience these symptoms, it’s crucial to seek emergency medical attention immediately. Adrenal crisis is a medical emergency that requires prompt treatment.

The primary treatment for an adrenal crisis involves the immediate administration of intravenous (IV) or intramuscular (IM) hydrocortisone, a steroid that acts like cortisol. IV fluids often accompany this to combat dehydration and restore normal blood pressure and blood sugar levels. Once stabilized, doctors will continue to monitor and adjust your treatment as necessary.

For individuals with adrenal insufficiency, preventing an adrenal crisis is critical. Taking the following steps can decrease your risk of experiencing adrenal crisis:

• Medication Adherence: Always take your prescribed medications as directed to maintain sufficient cortisol levels.
• Stress Doses: Learn how to adjust your medication during stress or illness under the guidance of your healthcare provider. This often means increasing your dose of steroids.
• Emergency Injectable Hydrocortisone: Keep an emergency kit containing injectable hydrocortisone, and make sure you and those close to you know how to use it if you cannot take your oral medications.
• Medical Alert Identification: Wear a medical alert bracelet or carry a card that indicates you have adrenal insufficiency, which can inform healthcare professionals of your condition in an emergency.

Understanding the signs of an adrenal crisis and knowing the steps to take in an emergency can effectively manage this condition and reduce your risk. Regular follow-ups with your healthcare provider are also essential to ensure your treatment plan remains appropriate for your needs.