The adrenal glands, small glands located on top of the kidneys, produce hormones for many bodily functions. Adrenal insufficiency occurs when these glands fail to produce sufficient amounts of these hormones, particularly cortisol and aldosterone. Cortisol is involved in the body’s response to stress and helps regulate blood pressure, while aldosterone manages the balance of sodium and potassium. When production is inadequate, it can affect the body’s balance of water, blood pressure control, and reaction to stress.
Common Symptoms of Adrenal Insufficiency
The onset of adrenal insufficiency is often slow, with symptoms that can be easily mistaken for other common health issues, which frequently leads to delays in diagnosis. One of the most reported symptoms is a persistent fatigue that is not alleviated by rest. This is often accompanied by muscle weakness.
Many individuals experience a loss of appetite and unexplained weight loss. Digestive issues are also prevalent and can include nausea, vomiting, or diarrhea, which can contribute to dehydration. Another common sign is low blood pressure, or postural hypotension, where a person feels dizzy or may faint upon standing.
A distinctive symptom that can arise is a craving for salty foods, which is related to the body losing sodium. Mood changes, such as irritability and a reduced ability to cope with stress, are also frequently observed. Recognizing these symptoms as a potential pattern is an important step toward seeking a medical evaluation.
Symptom Differences in Primary and Secondary Insufficiency
Adrenal insufficiency is categorized into primary and secondary types, distinguished by their underlying causes and symptoms. Primary adrenal insufficiency, also known as Addison’s disease, occurs when the adrenal glands are damaged and cannot produce enough hormones. This damage is often the result of an autoimmune reaction, where the body’s immune system attacks the glands.
Secondary adrenal insufficiency originates from a problem with the pituitary gland, a small gland at the base of the brain. The pituitary gland produces adrenocorticotropic hormone (ACTH), which signals the adrenal glands to release cortisol. In secondary insufficiency, the pituitary does not produce enough ACTH, leading to a drop in cortisol production.
A significant distinguishing feature is hyperpigmentation, or a darkening of the skin, which is characteristic of primary adrenal insufficiency but not the secondary type. This darkening may appear as patches on the skin and can also affect the inside of the mouth, gums, and areas of scarring. Because primary insufficiency involves a lack of both cortisol and aldosterone, symptoms like severe dehydration, low blood pressure, and salt cravings can be more pronounced.
Symptoms of an Adrenal Crisis
An adrenal crisis, or acute adrenal insufficiency, is a sudden worsening of symptoms that constitutes a life-threatening medical emergency. This can occur when a person with untreated adrenal insufficiency is exposed to significant physical stress, such as an injury, infection, or surgery. The symptoms of a crisis are more intense and appear more rapidly than those of chronic adrenal insufficiency.
The hallmarks of an adrenal crisis include sudden, intense pain in the lower back, abdomen, or legs. Severe vomiting and diarrhea are common, leading to significant dehydration. This can progress to a state of shock, with extremely low blood pressure and potential kidney failure.
A person experiencing an adrenal crisis may also exhibit neurological symptoms, such as confusion or loss of consciousness, and a high fever can be present. Due to the rapid progression of these symptoms, seek immediate emergency medical attention if an adrenal crisis is suspected. Prompt treatment is necessary to prevent fatal outcomes.
The Diagnostic Process
Diagnosing adrenal insufficiency begins with a review of a patient’s symptoms and medical history. Because the symptoms can be vague, a doctor will look for a pattern of signs like unexplained weight loss, fatigue, and low blood pressure. If adrenal insufficiency is suspected, specific laboratory tests are required for confirmation.
Blood tests are a central part of the diagnostic process. These tests measure the levels of sodium, potassium, cortisol, and adrenocorticotropic hormone (ACTH). In primary adrenal insufficiency, blood tests often show low sodium, high potassium, low cortisol, and high ACTH levels. In secondary adrenal insufficiency, ACTH levels are low.
The most definitive diagnostic tool is the ACTH stimulation test. During this test, a synthetic form of ACTH is injected, and blood cortisol levels are measured before and after. This test assesses how well the adrenal glands respond to the signal to produce cortisol. A limited or absent response from the adrenal glands confirms the diagnosis.