Primary
The most common signs of adrenal crisis are shock (very low blood pressure with a loss of consciousness), dehydration, and an imbalance of sodium and potassium levels in the body. In some cases, shock is preceded by fever; nausea, vomiting, and abdominal pain; weakness or fatigue; and confusion.
How do doctors treat adrenal insufficiency? Your doctor will prescribe hormone medicines to replace the hormones that your adrenal glands aren't making. You'll need higher doses during times of physical stress.
Addison's disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands will not be able to produce enough of the steroid hormones cortisol and aldosterone.
Adrenal insufficiency can be diagnosed by blood tests and special stimulation tests that show inadequate levels of adrenal hormones. Proponents of the adrenal fatigue diagnosis claim this is a mild form of adrenal insufficiency caused by chronic stress.
Symptoms said to be due to adrenal fatigue include tiredness, trouble falling asleep at night or waking up in the morning, salt and sugar craving, and needing stimulants like caffeine to get through the day. These symptoms are common and non-specific, meaning they can be found in many diseases.
Symptoms of AI include fatigue, muscle weakness, decreased appetite, and weight loss. Some people experience lightheadedness, dizziness, nausea, vomiting, abdominal pain, and diarrhea. Other symptoms include: Pain in the muscles and joints.
Treatment is tailored to the underlying cause and, in most cases, lifelong treatment is necessary. With appropriate treatment and a few added precautions, people with adrenal insufficiency can lead active lives and have a normal life expectancy.
Although there's no cure, primary adrenal insufficiency can be managed effectively by taking cortisol and aldosterone replacement hormones, with the goal of stabilizing hormone levels and relieving signs and symptoms.
Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6–12 months.
If Addison's disease is left untreated, the levels of hormones produced by the adrenal gland gradually decrease in the body. This causes your symptoms to get progressively worse and eventually lead to a life-threatening situation called an adrenal or Addisonian crisis.
Adrenal insufficiency can be caused by diseases of the adrenal gland (primary), interference with corticotropin (ACTH) secretion by the pituitary gland (secondary), or interference with corticotropin-releasing hormone (CRH) secretion by the hypothalamus (tertiary).
The most serious complication of adrenal insufficiency is called adrenal crisis. If not treated right away, adrenal crisis can cause death. Your body needs much more cortisol than usual during times of physical stress such as illness, serious injury, or surgery.
ACTH Stimulation Test This is the most specific test for diagnosing adrenal insufficiency. Blood cortisol levels are measured before and after a synthetic form of adrenocorticotrophic hormone (ACTH), a hormone secreted from the anterior pituitary, is given by injection.
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.
You may be too exhausted even to manage your daily affairs. In most cases, there's a reason for the fatigue. It might be allergic rhinitis, anemia, depression, fibromyalgia, chronic kidney disease, liver disease, lung disease (COPD), a bacterial or viral infection, or some other health condition.
Hydrocortisone (Cortef), prednisone (Rayos) or methylprednisolone (Medrol) to replace cortisol. These hormones are given on a schedule to act like the changes in cortisol levels the body goes through over 24 hours. Fludrocortisone acetate to replace aldosterone.
A medicine called hydrocortisone is usually used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, although these are less commonly used. Aldosterone is replaced with a medicine called fludrocortisone.
Treatment involves taking corticosteroids, a drug that mimics cortisol, for the rest of your life to replace the hormones that your body is not producing. Your endocrinologist will order tests periodically to ensure that your hormone levels are normal.