Understanding Secondary Adrenal Insufficiency

Adrenal insufficiency occurs when the adrenal glands are not working properly. They don’t make enough of the hormone cortisol.

You have 2 adrenal glands. They are located on top of the kidneys. They work with the hypothalamus and pituitary glands in the brain to make cortisol and several other hormones. These hormones help break down fats, proteins, and carbohydrates in your body. They also control blood pressure and your body's response to stress. They also affect how your immune system works.

There are 3 types of adrenal insufficiency. They are:

• Primary. This type is known as Addison disease. It occurs when the adrenal glands are damaged. They don’t make enough of the hormones cortisol and aldosterone. This type is rare. It may happen at any age.

• Secondary. In this type, the pituitary gland doesn’t make enough of the hormone ACTH (adrenocorticotropin). ACTH stimulates the adrenals to produce cortisol. Without it, the adrenal glands don’t make enough of it.

• Tertiary. This type is centered in the hypothalamus. This part of the brain doesn’t make a hormone that causes the pituitary gland to make ACTH. So the adrenal glands don’t make enough cortisol.

What causes secondary adrenal insufficiency?

A lack of the hormone ACTH leads to this type of adrenal insufficiency. It often stems from a problem with the pituitary gland, such as:

• A tumor.

• An infection or disease like tuberculosis.

• An injury to the gland.

• Rare genetic problems that change how much ACTH is made.

It can also happen if you must take certain steroids for a long time. People with health problems that require oral steroids repeatedly or over a prolonged period, like severe asthma or rheumatoid arthritis, are at risk. Over the years, the function of your pituitary will need to be checked to be sure you don't develop problems with other hormones released by your pituitary.

Symptoms of secondary adrenal insufficiency

Symptoms may occur a bit differently in each person. They may come on slowly. They may be worse under physical stress. You may have:

• Tiredness (fatigue).

• Weakness.

• Weight loss.

• Nausea.

• Vomiting.

• Diarrhea.

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

Treatment for secondary adrenal insufficiency

You will need to take hormones to replace the cortisol that your adrenal glands are not making. You will also be tested for other pituitary hormones to make sure that you are still making them. You will have to take medicines, such as hydrocortisone or prednisone.

Take your medicine exactly as you are told. You may have to take these medicines a couple times a day. You may also have to change your dose if you become sick, are injured, or face some other physical stress.

You should also carry a medical alert card or tag at all times. This can make sure you get the right care if there is an emergency. When traveling, always carry an emergency kit with a shot of hydrocortisone or dexamethasone.

Possible complications of secondary adrenal insufficiency

The main complication is adrenal crisis. This can be life-threatening. It can happen if your body is stressed, such as from an illness, surgery, or dehydration. Symptoms start quickly. Get medical care right away if you have:

• Severe belly pain.

• Vomiting and diarrhea.

• Weakness.

• Confusion.

• Loss of consciousness.

When to contact your doctor

Anything that stresses your body can affect how much medicine you need. Contact your doctor or seek medical care right away if:

• You have any kind of sickness, especially a fever or diarrhea.

• You become pregnant.

• You need surgery.

Get medical care right away if you have symptoms of adrenal crisis.