Adrenal Insufficiency
1 medicine
Adrenal insufficiency happens when the adrenal glands can't produce enough cortisol, and sometimes aldosterone, disrupting blood pressure, blood sugar and the body's response to stress. It is treated with lifelong hormone replacement.
Key facts
- Adrenal insufficiency means the adrenal glands, two small glands above the kidneys, can't make enough cortisol; aldosterone may also be affected, particularly in primary adrenal insufficiency (Addison's disease).
- Fatigue that doesn't improve with rest is often the first sign, alongside low blood pressure (especially on standing), salt cravings, unintentional weight loss, nausea, and muscle weakness.
- Treatment is lifelong hormone therapy: hydrocortisone (or an equivalent glucocorticoid) replaces cortisol daily, and fludrocortisone is added when aldosterone is also deficient.
- An adrenal crisis, sudden severe vomiting, extreme weakness, or a sharp drop in blood pressure, is a medical emergency requiring immediate hospital care.
Recognising the condition
Fatigue that doesn't improve with rest is often the first sign. Other common symptoms include low blood pressure (especially on standing), salt cravings, unintentional weight loss, nausea, and muscle weakness. Skin darkening around joints and scars is specific to primary adrenal insufficiency and reflects rising ACTH levels. Symptoms can stay vague for months before a diagnosis is made.
Replacing what the glands can't make
Treatment centres on lifelong hormone therapy to replace the missing hormones. Cortisol is replaced daily with hydrocortisone or an equivalent glucocorticoid. When aldosterone is also deficient, fludrocortisone is added to restore salt and fluid balance. Doses are typically increased during illness, surgery, or significant physical stress, a practice known as sick-day dosing.
When to seek urgent care
An adrenal crisis, marked by sudden severe vomiting, extreme weakness, or a sharp drop in blood pressure, is a medical emergency requiring immediate hospital care. Anyone on hormone replacement should carry an emergency steroid card or equivalent alert and know how to adjust their dose during illness.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.