What is Secondary Adrenal Insufficiency

There are two types of adrenal insufficiency.  The first, Addison’s Disease, is an autoimmune disease where the adrenal glands are damaged and can no longer produce enough of the adrenal hormone, cortisol.

The second type, and the type that this article is focussing on, is called Secondary Adrenal Insufficiency and is commonly the result of long term steroid use.  With long term use of prednisone or other corticosteroids, the body can stop producing its own cortisol.  This is why corticosteroids should never be stopped abruptly, and should always be gradually tapered down in dose, to allow the body’s natural cortisol production to re-establish.

In most cases, the adrenal glands will recover, though it may take some months.  Sometimes, however, the body doesn’t recover and doesn’t make enough cortisol to function.  The patient then has to take corticosteroids, such as prednisone, hydrocortisone or dexamethasone for the rest of their life.

This sounds relatively simple, but prednisone comes with a whole host of negative side effects.  It can affect mood, cause weight gain, decrease bone density, increase blood sugar, cholesterol and blood pressure, and cause cataracts.

What do adrenal hormones (cortisol and aldosterone) do?

The adrenal hormones regulate several body functions.  They help your body handle stress (are responsible for the ‘fight or flight’ reaction), regulate blood pressure, the balance of salt and fluids in your body and control how your body uses carbohydrates, fats and proteins.

What is adrenal crisis?

Stress can overwhelm a person who suffers from Adrenal Insufficiency.  An stressful incident, e.g. a car accident, or surgery, can put stress on the body that normally would be combatted with increased production of cortisol. But when the body can’t produce enough cortisol and other adrenal hormones,  the person suffers adrenal crisis.

This is a medical emergency and can very quickly become life threatening.  It requires immediate treatment with intravenous corticosteroids and fluids.

People who suffer adrenal insufficiency need to be treated with extra corticosteroids before and after surgery and when other stressful events occur to prevent an adrenal crisis.  A bad flu or virus or even dehydration can stress the body and bring on a crisis.

Symptoms of Adrenal Insufficiency

• chronic, severe fatigue
• muscle weakness
• loss of appetite
• weight loss
• abdominal pain
• nausea and vomitting
• low blood pressure that drops further when standing up, causing dizziness or fainting
• irritability or depression
• craving salt
• low blood sugar
• headache
• sweating
• irregular menstrual periods
• sweating

These symptoms often progress slowly and are often ignored until a stressful event, such as illness, surgery or an accident causes them to worse or become and Adrenal Crisis.

Symptoms of Adrenal Crisis

In most cases, people have been feeling terrible enough so that they have sought medical treatment for adrenal insufficiency.  Sometimes, however, symptoms appear for the first time during an adrenal crisis.  Symptoms of adrenal crisis include:

• severe vomitting and/or diarrhea
• severe abdominal pain, or pain in the lower back or legs
• low blood pressure
• loss of consciousness

How is adrenal crisis treated?

Adrenal crisis is treated by replacing adrenal hormones (most commonly cortisol and aldosterone).  People in adrenal crisis need immediate treatment, or the condition can be fatal.  The hormones can be given as an injection or by mouth.

A person with known adrenal insufficiency should carry a corticosteroid injection at all times.  The should also carry identification stating ‘Adrenal insufficiency’ in case of emergency, e.g. a car accident.